Provider Demographics
NPI:1093407256
Name:BOLDEN, BRANDON LEE (ABO, NCLE, LDO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:BOLDEN
Suffix:
Gender:M
Credentials:ABO, NCLE, LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6797 STATE HIGHWAY 303 NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3736
Mailing Address - Country:US
Mailing Address - Phone:360-692-0923
Mailing Address - Fax:360-692-4263
Practice Address - Street 1:6797 STATE HIGHWAY 303 NE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3736
Practice Address - Country:US
Practice Address - Phone:360-692-0923
Practice Address - Fax:360-692-4263
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO61408776156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician