Provider Demographics
NPI:1629482823
Name:RUSHING, BRANDON (OD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:RUSHING
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 1:6060 PRIMACY PKWY
Mailing Address - Street 2:#200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5745
Mailing Address - Country:US
Mailing Address - Phone:901-761-4620
Mailing Address - Fax:901-761-3072
Practice Address - Street 1:6060 PRIMACY PKWY
Practice Address - Street 2:#200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5745
Practice Address - Country:US
Practice Address - Phone:901-761-4620
Practice Address - Fax:901-761-3072
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3180152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist