Provider Demographics
NPI:1134250640
Name:RICHARD D BRANNEN OD PLLC
Entity type:Organization
Organization Name:RICHARD D BRANNEN OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRANNEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-643-2140
Mailing Address - Street 1:45 LYME RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1219
Mailing Address - Country:US
Mailing Address - Phone:603-643-2140
Mailing Address - Fax:603-643-1437
Practice Address - Street 1:45 LYME RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1219
Practice Address - Country:US
Practice Address - Phone:603-643-2140
Practice Address - Fax:603-643-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0227152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH5875200001Medicare NSC
NHRE8983Medicare PIN
NHT25678Medicare UPIN