Healthcare Provider Details

I. General information

NPI: 1982602728
Provider Name (Legal Business Name): LOWELL PARDEE BRANSON 0.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8332 N 7TH ST
PHOENIX AZ
85020-3441
US

IV. Provider business mailing address

8332 N 7TH ST
PHOENIX AZ
85020-3441
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-2656
  • Fax: 602-870-4605
Mailing address:
  • Phone: 602-944-2656
  • Fax: 602-870-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0022
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: