Individual
BRANDON JOHN KELLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DISPENSING OPTICIAN
Contact information
Practice address
230 E MARYDALE AVE, SOLDOTNA, AK 99669-7648
(907) 262-3119
(907) 262-9290
Mailing address
1806 MIRANDA CT, KENAI, AK 99611-6658
(907) 320-0663
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
202907
AK
Other
Enumeration date
07/10/2024
Last updated
07/10/2024
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