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NPI Code Detail

MEDICARE: TODD BRANTLEY OD

MEDICARE: TODD BRANTLEY OD
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
1152W00000XOptometrist5711 TGTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16849458OTHERTXCIGNA
281296QOTHERTXBLUE CROSS BLUE SHIELD
37387530OTHERTXAETNA UPIN#

General Provider Information

NPI Number : 1760595631
Entity Type Code : Individual
Provider Name (Legal Business Name) : TODD BRANTLEY OD
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 06/19/2019

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