Provider Demographics
NPI:1801971668
Name:DODDS, BRANDON LEE (OD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LEE
Last Name:DODDS
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 1:631 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:TN
Mailing Address - Zip Code:38059
Mailing Address - Country:US
Mailing Address - Phone:731-627-1100
Mailing Address - Fax:731-627-0011
Practice Address - Street 1:631 W MAIN ST
Practice Address - Street 2:DODDS EYE CARE PLC
Practice Address - City:NEWBERN
Practice Address - State:TN
Practice Address - Zip Code:38059
Practice Address - Country:US
Practice Address - Phone:731-627-1100
Practice Address - Fax:731-627-0011
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3945921Medicare ID - Type Unspecified
U96259Medicare UPIN
P00469733Medicare PIN