Provider Demographics
NPI:1750341244
Name:DABNEY, BRANDON WAYNE (OPTOMETRIST)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:WAYNE
Last Name:DABNEY
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3009
Mailing Address - Country:US
Mailing Address - Phone:806-355-9536
Mailing Address - Fax:806-353-5572
Practice Address - Street 1:2700 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3009
Practice Address - Country:US
Practice Address - Phone:806-355-9536
Practice Address - Fax:806-353-5572
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6436TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00152SMedicare PIN
TX8G5807Medicare PIN
TX4406730001Medicare NSC
TXCJ6720Medicare PIN
TXP00295154Medicare PIN
TX8J3189Medicare PIN
TX8G3155Medicare PIN
TXU96178Medicare UPIN
TX4504500001Medicare NSC
TXP00317256Medicare PIN