Provider Demographics
NPI:1164459301
Name:BRYANT, STEVEN ALLAN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLAN
Last Name:BRYANT
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 1:119 W 7TH
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-2801
Mailing Address - Country:US
Mailing Address - Phone:785-243-2175
Mailing Address - Fax:785-243-4370
Practice Address - Street 1:119 W 7TH
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-2801
Practice Address - Country:US
Practice Address - Phone:785-243-2175
Practice Address - Fax:785-243-4370
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14203152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS043354OtherBLUE CROSS BLUE SHIELD
KS100220150AMedicaid
KS043354OtherBLUE CROSS BLUE SHIELD
KS100220150AMedicaid
KS0914840001Medicare NSC