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NPI Code Detail

MEDICARE: TODD R. BRANTLEY, O.D., P.A.

MEDICARE: TODD R. BRANTLEY, O.D., P.A.
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
1152W00000XOptometrist5711TGTX

General Provider Information

NPI Number : 1750550877
Entity Type Code : Organization
Provider Name (Legal Business Name) : TODD R. BRANTLEY, O.D., P.A.
Provider Business Mailing Address
First Line : 5044 TENNYSON PKWY STE B
Second Line :
City : PLANO
State : TX
Zip : 75024-2953
Country : US
Telephone Number : 972-378-4104
Fax Number : 972-378-9094
Provider Business Practice Location Address
First Line : 5044 TENNYSON PKWY STE B
Second Line :
City : PLANO
State : TX
Zip : 75024-2953
Country : US
Telephone Number : 972-378-4104
Fax Number : 972-378-9094
Authorized Official
Title or Position : OWNER
Name : DR. TODD R. BRANTLEY
Credential : O.D.
Telephone Number : 972-378-4104
Provider Enumeration Date : 02/22/2008
Last Update Date : 06/19/2019

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