Provider Demographics
NPI:1114258209
Name:HARRIS, BRANDON PATRICK (OD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:PATRICK
Last Name:HARRIS
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 1:19 SUDAN ST # 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-1319
Mailing Address - Country:US
Mailing Address - Phone:360-961-6074
Mailing Address - Fax:
Practice Address - Street 1:19 SUDAN ST # 2
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-1319
Practice Address - Country:US
Practice Address - Phone:360-961-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program