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General NPI Number Information
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NPI Number | 1235218496
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Entity Type | Organization
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Legal Business Name | BRANCH & STAFFORD OPTOMETRIC ASSOCIATES, PA
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 7455 IRMO DR
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City | COLUMBIA
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State | SC
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Zip | 29212-8636
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Country | US
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Telephone | 803-781-2212
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Fax | 803-233-2883
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Provider Business Mailing Address
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Address Line | PO BOX 227
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City | IRMO
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State | SC
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Zip | 29063-0227
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Country | US
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Telephone | 803-781-2212
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Fax | 803-233-2883
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT BRANCH
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Credential | OD
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Telephone | 803-781-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 609,696,496,1336
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License Number State | SC
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