Provider Demographics
NPI:1811653942
Name:HALIM, BRANNON (OD)
Entity type:Individual
Prefix:
First Name:BRANNON
Middle Name:
Last Name:HALIM
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 1:1015 VICTORIA PARK
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-2637
Mailing Address - Country:US
Mailing Address - Phone:805-551-5069
Mailing Address - Fax:
Practice Address - Street 1:173 PLAZA DR STE 1009
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-3708
Practice Address - Country:US
Practice Address - Phone:707-917-4053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35070152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist