Individual
JON BRANTON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
451 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7229
(318) 222-5555
(318) 222-6414
Mailing address
451 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7229
(318) 222-5555
(318) 222-6414
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
841-290T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1314251
—
LA
01
—
841-290T
STATE LIC#
LA
Enumeration date
03/03/2006
Last updated
07/08/2007
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