Provider Demographics
NPI:1639499494
Name:HYMAN, BRANDON SHANE (CPO)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:SHANE
Last Name:HYMAN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 36TH AVE NW STE 180
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2483
Mailing Address - Country:US
Mailing Address - Phone:405-447-5402
Mailing Address - Fax:405-447-5684
Practice Address - Street 1:3451 36TH AVE NW STE 180
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2483
Practice Address - Country:US
Practice Address - Phone:405-447-5402
Practice Address - Fax:405-447-5684
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPO79224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPO02663OtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, & PEDORTHICS