Individual
BRANDON RAY LA FUENTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCO, BADO
Contact information
Practice address
2104 BANDIT PT, EDMOND, OK 73025-2832
(405) 620-2543
Mailing address
2104 BANDIT PT, EDMOND, OK 73025-2832
(405) 620-2543
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
—
—
Other
Enumeration date
03/30/2016
Last updated
04/27/2017
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