Healthcare Provider Details

I. General information

NPI: 1972675452
Provider Name (Legal Business Name): DOROTHY JEAN BRANSON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MARKET ST
DENTON MD
21629-1039
US

IV. Provider business mailing address

320 MARKET ST
DENTON MD
21629-1039
US

V. Phone/Fax

Practice location:
  • Phone: 410-479-0500
  • Fax: 410-479-0877
Mailing address:
  • Phone: 410-479-0500
  • Fax: 410-479-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMDTA0588
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: