Provider Demographics
NPI:1952467052
Name:DRS. BRANNON & BRANNON, OPTOMETRISTS, P.C.
Entity Type:Organization
Organization Name:DRS. BRANNON & BRANNON, OPTOMETRISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY, TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:PERRIN
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-269-4456
Mailing Address - Street 1:165 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-1944
Mailing Address - Country:US
Mailing Address - Phone:304-269-4456
Mailing Address - Fax:304-269-4468
Practice Address - Street 1:165 MAIN AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-1944
Practice Address - Country:US
Practice Address - Phone:304-269-4456
Practice Address - Fax:304-269-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1305095OtherUMWA NUMBER
WV0367200001Medicare NSC
WV1305095OtherUMWA NUMBER