Provider Demographics
NPI:1306253646
Name:SLOAN, BRANDON CARL (OD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:CARL
Last Name:SLOAN
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 1:1860 WOODMOOR DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9073
Mailing Address - Country:US
Mailing Address - Phone:719-488-2042
Mailing Address - Fax:
Practice Address - Street 1:1860 WOODMOOR DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9093
Practice Address - Country:US
Practice Address - Phone:719-488-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003072152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60688874Medicaid
CO60688874Medicaid