Provider Demographics
NPI:1154381101
Name:BRANCH, ROBERT WADE
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WADE
Last Name:BRANCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:506A OLD LEXINGTON HWY
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-0009
Mailing Address - Country:US
Mailing Address - Phone:803-345-3170
Mailing Address - Fax:803-233-2882
Practice Address - Street 1:506 OLD LEXINGTON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9823
Practice Address - Country:US
Practice Address - Phone:803-345-3170
Practice Address - Fax:803-233-2882
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD06090Medicaid
SCC14663Medicare PIN
SCD06090Medicaid