Provider Demographics
NPI:1407464043
Name:ALDERTON, BRANDON JAMES
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:JAMES
Last Name:ALDERTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 LEGACY FARM DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2592
Mailing Address - Country:US
Mailing Address - Phone:301-707-5420
Mailing Address - Fax:
Practice Address - Street 1:12181 COUNTY LINE RD STE 190
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7739
Practice Address - Country:US
Practice Address - Phone:256-233-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALS-E66-TA-C06152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program