Provider Demographics
NPI:1093999161
Name:DR SCOTT R BRANDAU OPTOMETRIST PC
Entity Type:Organization
Organization Name:DR SCOTT R BRANDAU OPTOMETRIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRANDAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-674-6824
Mailing Address - Street 1:5826 RUEBUSH RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-2252
Mailing Address - Country:US
Mailing Address - Phone:540-674-6824
Mailing Address - Fax:540-674-8916
Practice Address - Street 1:5826 RUEBUSH RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-2252
Practice Address - Country:US
Practice Address - Phone:540-674-6824
Practice Address - Fax:540-674-8916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000018152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010138833Medicaid
VAP00194747OtherRAILROAD MEDICARE
VAP00194747OtherRAILROAD MEDICARE
VAT21674Medicare UPIN
VAC09367Medicare PIN