Provider Demographics
NPI:1376104190
Name:D'ALLURA, BRIAN DANIEL
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DANIEL
Last Name:D'ALLURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WASHINGTON LN APT 703
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1415
Mailing Address - Country:US
Mailing Address - Phone:610-506-8537
Mailing Address - Fax:
Practice Address - Street 1:1278 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3343
Practice Address - Country:US
Practice Address - Phone:732-505-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00689100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist