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Individual
TODD BRANTLEY
Active
Individual
TODD BRANTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5711 TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6849458
CIGNA
TX
01
—
7387530
AETNA UPIN#
TX
01
—
81296Q
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/16/2006
Last updated
06/19/2019
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