Provider Demographics
NPI:1609562271
Name:BRANTON, BECK
Entity Type:Individual
Prefix:
First Name:BECK
Middle Name:
Last Name:BRANTON
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 1:410 THEATRE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2817
Mailing Address - Country:US
Mailing Address - Phone:814-269-3660
Mailing Address - Fax:814-269-2229
Practice Address - Street 1:410 THEATRE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2817
Practice Address - Country:US
Practice Address - Phone:814-269-3660
Practice Address - Fax:814-269-2229
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG004050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist