Provider Demographics
NPI:1770568677
Name:BRANSON, LESTER LAWRENCE (OD)
Entity type:Individual
Prefix:
First Name:LESTER
Middle Name:LAWRENCE
Last Name:BRANSON
Suffix:
Gender:M
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:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-0276
Mailing Address - Country:US
Mailing Address - Phone:410-479-2546
Mailing Address - Fax:410-479-0877
Practice Address - Street 1:320 MARKET ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1039
Practice Address - Country:US
Practice Address - Phone:410-479-0500
Practice Address - Fax:410-479-0877
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMDTA0577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036304OtherDAVIS VISION
MDX075LEOtherCAREFIRST BCBS
MD800902300Medicaid
MD900625OtherBLOCK VISION
MDBB06650OtherSPECTERA
T59925Medicare UPIN
MD900625OtherBLOCK VISION