Provider Demographics
NPI:1326064247
Name:BRYANT, NORMAN WAYNE (OD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:WAYNE
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 1:309 ELM
Mailing Address - Street 2:PO BOX 130
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342-3509
Mailing Address - Country:US
Mailing Address - Phone:870-338-8462
Mailing Address - Fax:870-338-8840
Practice Address - Street 1:309 ELM
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-3509
Practice Address - Country:US
Practice Address - Phone:870-338-8462
Practice Address - Fax:870-338-8840
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103738722Medicaid
AR0315550001Medicare NSC
AR49514Medicare ID - Type Unspecified
AR103738722Medicaid