Provider Demographics
NPI:1962873570
Name:BRANT, ANN (OD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BRANT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:CATHERINE
Other - Last Name:RAEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:115 W ROSE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1526
Mailing Address - Country:US
Mailing Address - Phone:602-714-4176
Mailing Address - Fax:
Practice Address - Street 1:115 W ROSE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1526
Practice Address - Country:US
Practice Address - Phone:602-714-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist