Provider Demographics
NPI:1346933884
Name:BRANNUM, CHERRY
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:
Last Name:BRANNUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17030 US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6733
Mailing Address - Country:US
Mailing Address - Phone:352-735-5900
Mailing Address - Fax:352-735-0218
Practice Address - Street 1:17030 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6733
Practice Address - Country:US
Practice Address - Phone:352-735-5900
Practice Address - Fax:352-735-0218
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL03588156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician