Provider Demographics
NPI:1669482600
Name:SARAH P BRANNON OD PC
Entity type:Organization
Organization Name:SARAH P BRANNON OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:PVLAT
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-785-3937
Mailing Address - Street 1:12100 KENNEDY LN
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA170333OtherAVESIS PROVIDER
VA410048278OtherMEDICARE RAILROAD
VA5161390001OtherDMES/ MEDICARE SUPPLIES
VA902137OtherBLOCK PROVIDER
VA4091903OtherAETNA PROVIDER
VA452927OtherANTHEM BC/BS PROVIDER
VA32467OtherMAMSI /UNITED HEALTHCARE
VA09235591Medicaid
VA2150133OtherFIRST HEALTH/MAILHANDLERS
VA5161390001OtherDMES/ MEDICARE SUPPLIES
VA=========OtherALLIANCE PROVIDER
VA=========OtherGREAT WEST PROVIDER
VA902137OtherBLOCK PROVIDER
VA452927OtherANTHEM BC/BS PROVIDER