Provider Demographics
NPI:1366500183
Name:BRILLIANT, RICHARD L (OPTOMETRY)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:BRILLIANT
Suffix:
Gender:M
Credentials:OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HIDDEN ACRES DR
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:215-276-1329
Practice Address - Street 1:100 W SPROUL RD
Practice Address - Street 2:SUITE 125
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2033
Practice Address - Country:US
Practice Address - Phone:610-690-4900
Practice Address - Fax:610-690-4910
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000447152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA67097OtherBLUE SHIELD
PAT28112Medicare UPIN
PA67097OtherBLUE SHIELD