Individual
BRANT MICHAEL SOUTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3201 LAKESIDE DR, RENO, NV 89509
(775) 825-0559
(775) 829-7918
Mailing address
3201 LAKESIDE DR, RENO, NV 89509-4830
(775) 825-0559
(775) 829-7918
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1727
AZ
152W00000X
Optometrist
Primary
779
NV
152W00000X
Optometrist
OD60235215
WA
Other
Enumeration date
11/24/2009
Last updated
08/30/2018
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