Provider Demographics
NPI:1134217672
Name:BASDEN, BRETT ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALAN
Last Name:BASDEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 N DEAN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4300
Mailing Address - Country:US
Mailing Address - Phone:334-887-6621
Mailing Address - Fax:334-826-2059
Practice Address - Street 1:780 N DEAN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4300
Practice Address - Country:US
Practice Address - Phone:334-887-6621
Practice Address - Fax:334-826-2059
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS765TA139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529926610Medicaid
ALK733Medicare ID - Type UnspecifiedPROVIDER NUMBER
AL529926610Medicaid