Organization
RONALD A. BRAKE,O.D.,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD ALLEN BRAKE O.D. (PRESIDENT)
(336) 766-6680
Entity
Organization
Contact information
Practice address
611 COLISEUM DR, SUITE B, WINSTON SALEM, NC 27106-5310
(336) 397-0768
Mailing address
3505 BURNLEY DR, CLEMMONS, NC 27012-8632
(336) 766-6680
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1384
NC
152WC0802X
Corneal and Contact Management Optometrist
1384
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174747851
—
NC
Enumeration date
01/20/2015
Last updated
01/20/2015
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