Provider Demographics
NPI:1508153990
Name:GUILLORY, JOHN BRANDON (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRANDON
Last Name:GUILLORY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2654 HIGHWAY 36 S
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-9600
Mailing Address - Country:US
Mailing Address - Phone:979-836-1077
Mailing Address - Fax:979-830-1573
Practice Address - Street 1:2654 HIGHWAY 36 S
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-9600
Practice Address - Country:US
Practice Address - Phone:979-836-1077
Practice Address - Fax:979-830-1573
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7744TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist