Provider Demographics
NPI:1376772319
Name:HATHORNE, BRANDI LEA (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:LEA
Last Name:HATHORNE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LEA
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9785 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-9406
Mailing Address - Country:US
Mailing Address - Phone:540-891-1290
Mailing Address - Fax:540-834-4289
Practice Address - Street 1:9785 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407
Practice Address - Country:US
Practice Address - Phone:540-891-1290
Practice Address - Fax:540-834-4289
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001844152W00000X
MDTA2170152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist