Basic Information
| Provider Information | |||||||||
| NPI: | 1922778471 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANNUM | ||||||||
| FirstName: | AARON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 W KENT AVE | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598016772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065413937 | ||||||||
| FaxNumber: | 4065413811 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 W KENT AVE | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598016772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065413937 | ||||||||
| FaxNumber: | 4065413811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2021 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.