Provider Demographics
NPI:1083747919
Name:HUSKEY, BRYAN DALE (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DALE
Last Name:HUSKEY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 PALMER HWY
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-7142
Mailing Address - Country:US
Mailing Address - Phone:409-945-7131
Mailing Address - Fax:409-945-7131
Practice Address - Street 1:2328 PALMER HWY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-7142
Practice Address - Country:US
Practice Address - Phone:409-945-7131
Practice Address - Fax:409-745-7131
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX928908Medicaid
TX928908Medicaid