Provider Demographics
NPI:1861466203
Name:BRANDON, MARSHA A (OD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:A
Last Name:BRANDON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9456 LOOKOUT POINT DR
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848
Mailing Address - Country:US
Mailing Address - Phone:517-651-5154
Mailing Address - Fax:517-651-6608
Practice Address - Street 1:252 E GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848
Practice Address - Country:US
Practice Address - Phone:517-651-6608
Practice Address - Fax:517-651-6608
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003617152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3617OtherEYEMED
MI4903617Medicaid
U37075Medicare UPIN
MI3617OtherEYEMED