Provider Demographics
NPI:1194889220
Name:JAMES, BRENDAN RICHARD (OD)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:RICHARD
Last Name:JAMES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1105
Mailing Address - Country:US
Mailing Address - Phone:209-526-2737
Mailing Address - Fax:209-338-0074
Practice Address - Street 1:1019 16TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1105
Practice Address - Country:US
Practice Address - Phone:209-526-2737
Practice Address - Fax:209-338-0074
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12588T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV02158Medicare UPIN