Provider Demographics
NPI:1194836312
Name:BRANSCOME, SHARON MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:MARIE
Last Name:BRANSCOME
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:GRUBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4377 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8792
Mailing Address - Country:US
Mailing Address - Phone:850-995-4555
Mailing Address - Fax:
Practice Address - Street 1:4377 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8792
Practice Address - Country:US
Practice Address - Phone:850-995-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4177152W00000X
FLOPC 004177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112471500Medicaid
FLXB20DOtherBCBS OF FL