Healthcare Provider Details

I. General information

NPI: 1194836312
Provider Name (Legal Business Name): SHARON MARIE BRANSCOME O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHARON MARIE GRUBB OD

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N JOHN SIMS PKWY
VALPARAISO FL
32580-1005
US

IV. Provider business mailing address

111 N JOHN SIMS PKWY
VALPARAISO FL
32580-1005
US

V. Phone/Fax

Practice location:
  • Phone: 850-729-8711
  • Fax: 850-729-8713
Mailing address:
  • Phone: 850-729-8711
  • Fax: 850-729-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: