Provider Demographics
NPI:1588829485
Name:PERZINSKI, BRANDEN L (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDEN
Middle Name:L
Last Name:PERZINSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4788 48TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6040
Mailing Address - Country:US
Mailing Address - Phone:503-347-6948
Mailing Address - Fax:
Practice Address - Street 1:4731 13TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7269
Practice Address - Country:US
Practice Address - Phone:701-281-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist