Provider Demographics
NPI:1215020342
Name:SUTTON, BRENDA I (OD)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:I
Last Name:SUTTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:I
Other - Last Name:RODRIGUEZ-AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1599 BOTELHO DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5102
Mailing Address - Country:US
Mailing Address - Phone:925-945-8300
Mailing Address - Fax:925-945-8757
Practice Address - Street 1:1599 BOTELHO DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5102
Practice Address - Country:US
Practice Address - Phone:925-945-8300
Practice Address - Fax:925-945-8757
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11812T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU91694Medicare UPIN