MEDICARE: DR. JOHN BRANDON GUILLORY O.D.

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	7744TG	TX

General Provider Information

NPI Number	:	1508153990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BRANDON GUILLORY O.D.

Provider Business Mailing Address
First Line	:	2654 HIGHWAY 36 S
Second Line	:
City	:	BRENHAM
State	:	TX
Zip	:	77833-9600
Country	:	US
Telephone Number	:	979-836-1077
Fax Number	:	979-830-1573

Provider Business Practice Location Address
First Line	:	2654 HIGHWAY 36 S
Second Line	:
City	:	BRENHAM
State	:	TX
Zip	:	77833-9600
Country	:	US
Telephone Number	:	979-836-1077
Fax Number	:	979-830-1573

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

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/05/2012

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