Provider Demographics
NPI:1134290869
Name:BRANCH & STAFFORD OPTOMETRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:BRANCH & STAFFORD OPTOMETRIC ASSOCIATES, PA
Other - Org Name:EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-345-3170
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-0009
Mailing Address - Country:US
Mailing Address - Phone:803-345-3170
Mailing Address - Fax:803-233-2882
Practice Address - Street 1:506 OLD LEXINGTON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9823
Practice Address - Country:US
Practice Address - Phone:803-345-3170
Practice Address - Fax:803-233-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC609,696,496,1336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD06090Medicaid
SCD04966Medicaid
SCDA9916Medicaid
SCD04966Medicaid
SCD06090Medicaid