Provider Demographics
NPI:1871278697
Name:IGO, BRANDON ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ROBERT
Last Name:IGO
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 1:3705 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3071
Mailing Address - Country:US
Mailing Address - Phone:469-382-3835
Mailing Address - Fax:
Practice Address - Street 1:3705 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-3071
Practice Address - Country:US
Practice Address - Phone:469-382-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10871T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist