Provider Demographics
NPI:1871880369
Name:SMITH, BRANDON L (OD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:L
Last Name:SMITH
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 1:900 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7447
Mailing Address - Country:US
Mailing Address - Phone:785-823-7403
Mailing Address - Fax:785-825-8857
Practice Address - Street 1:900 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7447
Practice Address - Country:US
Practice Address - Phone:785-823-7403
Practice Address - Fax:785-825-8857
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7763T152W00000X
KS1903152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist