NPIMap

Organization Active NPI

Ronald a. Brake,O.D.,P.a.

  • Optometrist
  • Winston Salem, NC
National Provider Identifier
1982093563
Registry record updated Jan 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1384 Issued in NC
Legal business name
RONALD A. BRAKE,O.D.,P.A.
Practice address
611 Coliseum Dr
Suite B
Winston Salem, NC 27106-5310
Phone
(336) 397-0768
NPI assigned
Jan 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ronald Allen Brake, O.D.NPI 1174747851
Title
President
Phone
(336) 766-6680

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 1384 NC Primary
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X 1384 NC

Addresses

Primary practice location

611 Coliseum Dr
Suite B
Winston Salem, NC 27106-5310

Mailing address

3505 Burnley Dr
Clemmons, NC 27012-8632
Phone (336) 766-6680

Other identifiers 1

IdentifierTypeStateIssuer
1174747851MedicaidNC

National Provider Directory

National Provider Directory

Locations

611 Coliseum Dr
#B
Winston Salem, NC 27106
Phone (336) 397-0768

611 Coliseum Dr
Ste B
Winston Salem, NC 27106
Phone (336) 397-0768

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421712000000",
    "number": "1982093563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 BURNLEY DR",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128632",
            "telephone_number": "336-766-6680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 COLISEUM DR",
            "address_2": "SUITE B",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271065310",
            "telephone_number": "336-397-0768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RONALD A. BRAKE,O.D.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-20",
        "last_updated": "2015-01-20",
        "status": "A",
        "authorized_official_last_name": "BRAKE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-766-6680",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1384",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NC",
            "license": "1384",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174747851",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.