DR. SHANE BRAHM (NPI# 1831570761) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831570761 |
| Entity Type | Individual |
| Full Name | DR. SHANE BRAHM |
| Practice Address |
129 Old Abe Rd Lac Du Flambeau WI 54538-9386 |
| Practice Telephone | 7155883371 |
| Practice Fax Number | 7155882039 |
| Mailing Telephone | 7155883371 |
| Mailing Fax Number | 7155882039 |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2015-06-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 3376-35 | WI | Eye and Vision Services Providers |
| Street Address |
129 OLD ABE RD |
| City | LAC DU FLAMBEAU |
| State | WI |
| Zip Code | 54538-9386 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992795223 | Kenneth R Ninham | Counselor | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2005-10-27 |
| 1578175063 | Lucas C Daniels | Nurse Practitioner | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2020-08-18 |
| 1841801388 | Andrew Friedley | Pharmacist | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2020-08-10 |
| 1386255834 | Nicholis Ross Laporte | Pharmacist | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2020-08-10 |
| 1689145443 | Alissa R Martin | Social Worker | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2018-12-05 |
| 1831556901 | Katrina Angel Mares | Chiropractor | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2016-01-20 |
| 1447690375 | Emily E Busha | Physician Assistant | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2013-06-25 |
| 1770812505 | Scott C Kuehn | Counselor | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2009-12-07 |
| 1134235047 | Lac Du Flambeau Band of Lake Superior Chippewa Indians | Clinic/Center | 129 Old Abe Rd, Lac Du Flambeau, WI 54538-9386 | 2006-08-22 |
| 1447271408 | Lac Du Flambeau Band of Lake Superior Chippewa Indians | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 129 Old Abe Rd, Lac Du Flambeau, WI 54538 | 2006-07-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265757256 | Stacey Dean | Registered Nurse | 8727 West Squaw Lake Road, Lac Du Flambeau, WI 54538 | 2010-04-01 |
| 1447398532 | Wendy Lindstrom | Counselor | 533 Peace Pipe Rd, Lac Du Flambeau, WI 54538 | 2007-02-02 |
| 1932295581 | Rick Lee Howe | Pharmacist | 450 Ols Abe Road, Lac Du Flambeau, WI 54538 | 2006-10-04 |
| 1902990534 | Timothy P. Obukowicz | Pharmacist | 450 Old Abe Road, Lac Du Flambeau, WI 54538 | 2006-10-03 |
| 1295849420 | Brian D Schafer | Pharmacist | 129 Old Abe Road, Lac Du Flambeau, WI 54538 | 2006-08-17 |
| 1720071723 | Town of Lac Du Flambeau | Ambulance | 614 Wild Rice Avenue, Lac Du Flambeau, WI 54538 | 2005-08-24 |
| 1508223066 | Amber Bickler | Dental Hygienist | 128 Old Abe Road, Lac Du Flambeau, WI 54538 | 2016-01-28 |
| 1689712770 | Linda M Daniels | Counselor | 533 Peace Pipe Rd, Lac Du Flambeau, WI 54538 | 2007-02-02 |
| 1477611432 | Gary Louis Gusmerotti | Dentist | 128 Old Abe Rd, Lac Du Flambeau, WI 54538-0128 | 2006-12-04 |
| 1073940136 | Sarah Jean Galloy | Dental Hygienist | 128 Old Abe Road, Lac Du Flambeau, WI 54538-0128 | 2013-10-03 |
| Find all providers in zip 54538 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154939288 | Myeyedr Optometry of Wisconsin, LLC | Optometrist | 2505 N Mayfair Rd Ste 100, Wauwatosa, WI 53226-1404 | 2020-07-15 |
| 1689291254 | Lynne's Moc, LLC | Optometrist | 512 State Street, Madison, WI 53703 | 2020-06-30 |
| 1891311775 | Elizabeth Carman Somers | Optometrist | 3621 Market Ln, Kenosha, WI 53144-1553 | 2020-06-17 |
| 1760008619 | Melanie Nielsen | Optometrist | S73w16437 Janesville Rd, Muskego, WI 53150-9723 | 2020-06-16 |
| 1487278479 | Alyssa Chrisman | Optometrist | 2910 Roosevelt Rd # D1, Marinette, WI 54143-5108 | 2020-06-04 |
| 1043859341 | Site 4 Eyes | Optometrist | 7245 S 76th St, Franklin, WI 53132-9041 | 2020-01-03 |
| 1932745163 | Mauston Family Eyecare, LLC | Optometrist | 205 Division St Ste A, Mauston, WI 53948-2110 | 2019-11-22 |
| 1114562345 | Dr Christopher D Smith & Associates LLC | Optometrist | 2665 Monroe Rd Ste 100, De Pere, WI 54115-9287 | 2019-11-12 |
| 1013564111 | Ayman Tabani | Optometrist | 9160 76th St Unit C, Kenosha, WI 53158-1945 | 2019-08-22 |
| 1104473537 | Espy Specs Sc | Optometrist | 2720 Golf Rd, Eau Claire, WI 54701-8011 | 2019-08-21 |
| Find all providers with the same taxonomy | ||||
| City | LAC DU FLAMBEAU |
| Zip Code | 54538 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.