Provider Demographics
NPI:1215278510
Name:TODD R. BRANTLEY, LLC
Entity type:Organization
Organization Name:TODD R. BRANTLEY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERAILE
Authorized Official - Suffix:
Authorized Official - Credentials:CPOC
Authorized Official - Phone:972-378-4104
Mailing Address - Street 1:1060 S PRESTON RD
Mailing Address - Street 2:#100
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-3894
Mailing Address - Country:US
Mailing Address - Phone:972-382-2020
Mailing Address - Fax:972-378-9094
Practice Address - Street 1:1060 S PRESTON RD
Practice Address - Street 2:#100
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3894
Practice Address - Country:US
Practice Address - Phone:972-382-2020
Practice Address - Fax:972-378-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5711TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty