Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | R-214 | AL |
NPI | 1205907565 |
---|---|
Provider Name | Dr. Kenyatta D. Brantley |
First Address | Huntsville, AL 35802-2115 |
Second Address | Huntsville, AL 35802-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/01/2014 |