Provider Demographics
NPI:1184800450
Name:ALAN BRANSON, OD, PC
Entity type:Organization
Organization Name:ALAN BRANSON, OD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-332-8500
Mailing Address - Street 1:1435 N MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2171
Mailing Address - Country:US
Mailing Address - Phone:573-332-8500
Mailing Address - Fax:573-335-5080
Practice Address - Street 1:1435 N MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2171
Practice Address - Country:US
Practice Address - Phone:573-332-8500
Practice Address - Fax:573-335-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT2837152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952308546OtherNPI PERSONAL, OPTOMETRIST
1952308546OtherNPI PERSONAL, OPTOMETRIST
T96068Medicare UPIN