Individual
CHARLES TIMOTHY BRAKEFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OCULARIST
Contact information
Practice address
6401 ODANA RD STE 23, MADISON, WI 53719-1126
(608) 661-9030
(608) 661-9040
Mailing address
2725 MARSHALL CT, MADISON, WI 53705-2288
(608) 661-9030
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
036-0002195093-04
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0829340001
MEDICARE PTAN
WI
05
—
41744100
—
WI
Enumeration date
11/23/2016
Last updated
07/21/2022
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