Provider Demographics
NPI:1639853583
Name:BRANHAM, CYDNEY PAIGE (OD)
Entity Type:Individual
Prefix:
First Name:CYDNEY
Middle Name:PAIGE
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CYDNEY
Other - Middle Name:PAIGE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 LICK FRK
Mailing Address - Street 2:
Mailing Address - City:JENKINS
Mailing Address - State:KY
Mailing Address - Zip Code:41537-8323
Mailing Address - Country:US
Mailing Address - Phone:606-616-1179
Mailing Address - Fax:
Practice Address - Street 1:608 TRENT ST NE
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1532
Practice Address - Country:US
Practice Address - Phone:276-679-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist