Individual
MRS. ANN RENE BRAGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
691 SHOSHONE ST N, TWIN FALLS, ID 83301-6154
(208) 733-1067
(208) 733-7597
Mailing address
691 SHOSHONE ST N, TWIN FALLS, ID 83301-6154
(208) 733-1067
(208) 733-7597
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD485
ID
156FX1800X
Optician
601I
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010014411
BLUE SHIELD
ID
01
—
V2894
BLUE CROSS
ID
Enumeration date
10/12/2006
Last updated
06/11/2008
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