Provider Demographics
NPI:1851387427
Name:BRAN, ERIC LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LEE
Last Name:BRAN
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 1:96 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4069
Mailing Address - Country:US
Mailing Address - Phone:203-438-5855
Mailing Address - Fax:203-431-0318
Practice Address - Street 1:96 DANBURY RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4069
Practice Address - Country:US
Practice Address - Phone:203-438-5855
Practice Address - Fax:203-431-0318
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02686Medicare PIN
CTU94386Medicare UPIN