Provider Demographics
NPI:1972675452
Name:BRANSON, DOROTHY JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:JEAN
Last Name:BRANSON
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 1:320 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1039
Mailing Address - Country:US
Mailing Address - Phone:410-479-0500
Mailing Address - Fax:410-479-0877
Practice Address - Street 1:320 MARKET ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1039
Practice Address - Country:US
Practice Address - Phone:410-479-0500
Practice Address - Fax:410-479-0877
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMDTA0588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist