Healthcare Provider Details

I. General information

NPI: 1134250640
Provider Name (Legal Business Name): RICHARD D BRANNEN OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 LYME RD SUITE 201
HANOVER NH
03755-1219
US

IV. Provider business mailing address

45 LYME RD SUITE 201
HANOVER NH
03755-1219
US

V. Phone/Fax

Practice location:
  • Phone: 603-643-2140
  • Fax: 603-643-1437
Mailing address:
  • Phone: 603-643-2140
  • Fax: 603-643-1437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0227
License Number StateNH

VIII. Authorized Official

Name: DR. RICHARD D BRANNEN
Title or Position: SOLE MEMBER
Credential: OD
Phone: 603-643-2140