Provider Demographics
NPI:1073374179
Name:LAW, BRANDIE (ABO 152727: MAY 2001)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:ABO 152727: MAY 2001
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KINGS FORT PKWY
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-3575
Mailing Address - Country:US
Mailing Address - Phone:469-595-7072
Mailing Address - Fax:972-932-5026
Practice Address - Street 1:300 KINGS FORT PKWY
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-3575
Practice Address - Country:US
Practice Address - Phone:469-595-7072
Practice Address - Fax:972-932-5026
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician