Provider Demographics
NPI:1497446835
Name:BRANSCUM, CHELSEA JADE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:JADE
Last Name:BRANSCUM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-3163
Mailing Address - Country:US
Mailing Address - Phone:864-963-6168
Mailing Address - Fax:
Practice Address - Street 1:3950 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-3163
Practice Address - Country:US
Practice Address - Phone:864-963-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist