Provider Demographics
NPI:1033127808
Name:BRANDAU, SCOTT ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ROBERT
Last Name:BRANDAU
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 1:5826 RUEBUSH RD
Mailing Address - Street 2:4668 LEE HIGHWAY
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-2252
Mailing Address - Country:US
Mailing Address - Phone:540-674-6824
Mailing Address - Fax:540-674-8916
Practice Address - Street 1:5826 RUEBUSH RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-2252
Practice Address - Country:US
Practice Address - Phone:540-674-6824
Practice Address - Fax:540-674-8916
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA061800018152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010138833Medicaid
VA11525557OtherCAQH CREDENTIALING CENTER
VA00W233D01Medicare ID - Type Unspecified
VA010138833Medicaid