Provider Demographics
NPI:1235203266
Name:BRYAN K STERLING OD LLC
Entity Type:Organization
Organization Name:BRYAN K STERLING OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:STERLING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:302-734-3511
Mailing Address - Street 1:773A SOUTH QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904
Mailing Address - Country:US
Mailing Address - Phone:302-734-3511
Mailing Address - Fax:302-736-5862
Practice Address - Street 1:773A SOUTH QUEEN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-734-3511
Practice Address - Fax:302-736-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1172152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00257710OtherRAILROAD MEDICARE
DE0000249822Medicaid
5605150001Medicare NSC
DE0000249822Medicaid
DEG01923Medicare PIN