Provider Demographics
NPI:1265529051
Name:BRANCH, STEPHANIE (OD)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:BRANCH
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 1:11110 MALL CIRCLE, SUITE 2001
Mailing Address - Street 2:P.O. BOX 6210
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603
Mailing Address - Country:US
Mailing Address - Phone:301-705-8451
Mailing Address - Fax:301-705-8448
Practice Address - Street 1:11110 MALL CIRCLE
Practice Address - Street 2:SUITE 2001
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603
Practice Address - Country:US
Practice Address - Phone:301-705-8451
Practice Address - Fax:301-705-8448
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist