Provider Demographics
NPI:1538596119
Name:BRAGG, CYNDI
Entity type:Individual
Prefix:
First Name:CYNDI
Middle Name:
Last Name:BRAGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E LA SALLE AVE
Mailing Address - Street 2:
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-1426
Mailing Address - Country:US
Mailing Address - Phone:715-418-2125
Mailing Address - Fax:
Practice Address - Street 1:233 E LA SALLE AVE
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1426
Practice Address - Country:US
Practice Address - Phone:715-418-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier