Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | S-D63 | AL |
Y | 152W00000X | Optometrist | S-D63-TA-A44 | AL |
NPI | 1003263559 |
---|---|
Provider Name | Dr. Gussie Bell Branch |
First Address | Oneonta, AL 35121-4631 |
Second Address | Oneonta, AL 35121-4631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2016 |
Last Update Date | 10/08/2016 |