Provider Demographics
NPI:1871946228
Name:BRAVE OPTICAL INC
Entity type:Organization
Organization Name:BRAVE OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-402-4423
Mailing Address - Street 1:6579 MOUNTAIN SKY RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1306
Mailing Address - Country:US
Mailing Address - Phone:214-402-4423
Mailing Address - Fax:
Practice Address - Street 1:601 W PLANO PKWY STE 141
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8968
Practice Address - Country:US
Practice Address - Phone:214-402-4423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier