Brakefield, Charles Timothy
Brakefield, Charles Timothy is an sole proprietor health care provider with primary practice located at 6401 Odana Rd Ste 23 , Madison WI 53719-1126. He recently has only one registered license in Eye and Vision Services Providers / Ocularist, which is considered as his primary health care specialty. Brakefield, Charles Timothy can be contacted via phone (608) 661-9030.Contact Information
Primary practice address
6401 Odana Rd Ste 23
Madison WI 53719-1126
Phone: (608) 661-9030
Fax: (608) 661-9040
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Ocularist | 156FX1700X | 036-0002195093-04 | Wisconsin |
Profile Details
| NPI number | 1457894404 |
|---|---|
| LBN Legal business name | Brakefield, Charles Timothy |
| Credentials | OCULARIST |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 23rd, 2016 |
| Last updated | Jul 21st, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457894404 | NPPES |
| Wisconsin | MEDICAID | 41744100 | |
| Wisconsin | Other | 0829340001 |
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