Provider Demographics
NPI:1023098688
Name:BRANNON, SARAH PILAT (OD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:PILAT
Last Name:BRANNON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:PILAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:12100 KENNEDY LN
Mailing Address - Street 2:STE 206
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6760
Mailing Address - Country:US
Mailing Address - Phone:540-785-3937
Mailing Address - Fax:540-785-5498
Practice Address - Street 1:12100 KENNEDY LN
Practice Address - Street 2:STE 206
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6760
Practice Address - Country:US
Practice Address - Phone:540-785-3937
Practice Address - Fax:540-785-5498
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU95551Medicare UPIN
OH4108402Medicare ID - Type Unspecified
OH4108404Medicare ID - Type Unspecified
OH4108401Medicare ID - Type Unspecified
OH4108403Medicare ID - Type Unspecified