Provider Demographics
NPI:1548261746
Name:BRACKETT, CHRISTOPHER W (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:W
Last Name:BRACKETT
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 1:4405 BELLEMEADE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0682
Mailing Address - Country:US
Mailing Address - Phone:812-474-1010
Mailing Address - Fax:812-485-2476
Practice Address - Street 1:4405 BELLEMEADE AVE STE 101
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0682
Practice Address - Country:US
Practice Address - Phone:812-474-1010
Practice Address - Fax:812-485-2476
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003248A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000368900OtherANTHEM BLUE CROSS BLUE SH
IN000000501907OtherANTHEM BLUE CROSS BLUE SHIELD
INP00277379OtherRAILROAD MEDICARE
IN200434020AMedicaid
INU96449Medicare UPIN
IN000000501907OtherANTHEM BLUE CROSS BLUE SHIELD
IN395900001Medicare NSC
INP22577379Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IN231380AMedicare ID - Type UnspecifiedMEDICARE
IN200434020AMedicaid