Provider Demographics
NPI:1396706263
Name:BRANDENBURG, NHUNG H (OD)
Entity type:Individual
Prefix:DR
First Name:NHUNG
Middle Name:H
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:NHUNG
Other - Middle Name:T
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:
Practice Address - Street 1:20 GLENLAKE PARKWAY
Practice Address - Street 2:KAISER PERMANENTE GLENLAKE MEDICAL CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:770-952-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001655152W00000X
GA1655152W00000X
FL3091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7709526412OtherVISION SERVICE PLAN
GA207407180BMedicaid
GA21211586OtherUHC
GA207407180CMedicaid
GA207407180AMedicaid
GA40927OtherSPECTERA
GA52797520006OtherBLUE CROSS BLUE SHIELD
GA581594648OtherPHCS
GA582228848OtherVCP, CHEROKEE & DAWSON EY
GAGA1655OtherEYEMED
GA7709526413OtherVSP, MARK DICKINSON, OD
GA21211586OtherUHC
GA41ZCFMRMedicare ID - Type Unspecified