MEDICARE: BRANDIE LAW ABO 152727: MAY 2001

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1073374179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDIE LAW ABO 152727: MAY 2001

Provider Business Mailing Address
First Line	:	300 KINGS FORT PKWY
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142-3575
Country	:	US
Telephone Number	:	469-595-7072
Fax Number	:	972-932-5026

Provider Business Practice Location Address
First Line	:	300 KINGS FORT PKWY
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142-3575
Country	:	US
Telephone Number	:	469-595-7072
Fax Number	:	972-932-5026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2024
Last Update Date	:	01/17/2024

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