Provider Demographics
NPI:1538147061
Name:BRANCH, JAMES DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVID
Last Name:BRANCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 TOWN RUN LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3911
Mailing Address - Country:US
Mailing Address - Phone:336-723-0748
Mailing Address - Fax:336-721-4711
Practice Address - Street 1:224 TOWN RUN LN
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3911
Practice Address - Country:US
Practice Address - Phone:336-723-0748
Practice Address - Fax:336-721-4711
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC21915207W00000X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC17800OtherBLUE CROSS AND BLUE SHIEL
NC8917800Medicaid
NC17800OtherBLUE CROSS AND BLUE SHIEL
NC8917800Medicaid
NC201841DMedicare PIN
NC201841Medicare PIN
NC0593340001Medicare NSC