Provider Demographics
NPI:1003877028
Name:BRANNEN, RICHARD D (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:BRANNEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 LYME RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1219
Mailing Address - Country:US
Mailing Address - Phone:603-643-2140
Mailing Address - Fax:603-643-1437
Practice Address - Street 1:45 LYME RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1219
Practice Address - Country:US
Practice Address - Phone:603-643-2140
Practice Address - Fax:603-643-1437
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH227152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT7766OtherVT BC/BS
151239OtherHARVARD PILGRIM
NH2946OtherNH CIGNA
0907766YONH01OtherANTHEM
NHRE4485Medicare PIN
NHT25678Medicare UPIN