Healthcare Provider Details

I. General information

NPI: 1821402066
Provider Name (Legal Business Name): BRANDON MCFADDEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 E INDIANA AVE STE 5000
SPOKANE VALLEY WA
99216-1883
US

IV. Provider business mailing address

2255 N ROBINS DR STE 100
LAYTON UT
84041-1148
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-0107
  • Fax: 509-747-2635
Mailing address:
  • Phone: 801-773-0690
  • Fax: 801-773-0697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60475517
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14276730-9934
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOD60475517
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number14276730-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: