Provider Demographics
NPI:1003263559
Name:BRANCH, GUSSIE BELL (OD)
Entity Type:Individual
Prefix:DR
First Name:GUSSIE
Middle Name:BELL
Last Name:BRANCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 EBELL RD
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-4631
Mailing Address - Country:US
Mailing Address - Phone:256-276-6738
Mailing Address - Fax:
Practice Address - Street 1:1160 EBELL RD
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-4631
Practice Address - Country:US
Practice Address - Phone:256-276-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-14
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-D63-TA-A44152W00000X
ALS-D63152W00000X
AL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program