MEDICARE: BRANDON EYE CLINIC PLLC

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	152W00000X	Optometrist	PC-124	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17274000040	OTHER	AR	QUALCHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417067687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDON EYE CLINIC PLLC

Provider Business Mailing Address
First Line	:	1600 W SUNSET AVE
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-5136
Country	:	US
Telephone Number	:	479-756-1234
Fax Number	:	479-756-1087

Provider Business Practice Location Address
First Line	:	1600 W SUNSET AVE
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-5136
Country	:	US
Telephone Number	:	479-756-1234
Fax Number	:	479-756-1087

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHILIP F BRANDON
Credential	:	O.D.
Telephone Number	:	479-756-1234

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/20/2013

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Directions to “BRANDON EYE CLINIC PLLC ” Practice Location

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