Individual
BRANDON MARK THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2125 NW STEWART PKWY, ROSEBURG, OR 97471-1693
(541) 957-8552
Mailing address
552 W CENTER ST, ROSEBURG, OR 97471-2319
(541) 680-6242
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
253296
OR
Other
Enumeration date
11/29/2023
Last updated
11/29/2023
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