Individual
DR. PHILIP FRED BRANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1600 W SUNSET AVE, SPRINGDALE, AR 72762-5136
(479) 756-1234
(476) 756-1087
Mailing address
1600 W SUNSET AVE, SPRINGDALE, AR 72762-5136
(479) 756-1234
(476) 756-1087
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2370
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0336120001
PALMETTO
AR
01
—
17274000040
QUALCHOICE
AR
01
—
47744
BCBS
AR
Enumeration date
08/30/2006
Last updated
07/08/2007
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