Provider Demographics
NPI:1033273933
Name:ACTON, BRYAN M (OD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:M
Last Name:ACTON
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 1:5455 HARRISON PARK LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2245
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:12513 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9150
Practice Address - Country:US
Practice Address - Phone:317-254-6480
Practice Address - Fax:317-259-8609
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002960B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN894060GMedicare PIN
INU74102Medicare UPIN
IN0873400004Medicare NSC