Provider Demographics
NPI:1407901648
Name:BRYAN, BRIAN D (OD PA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:BRYAN
Suffix:
Gender:M
Credentials:OD PA
Other - Prefix:DR
Other - First Name:DON
Other - Middle Name:
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ODPA
Mailing Address - Street 1:20354 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2503
Mailing Address - Country:US
Mailing Address - Phone:305-652-5277
Mailing Address - Fax:305-652-8330
Practice Address - Street 1:20354 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-2503
Practice Address - Country:US
Practice Address - Phone:305-652-5277
Practice Address - Fax:305-652-8330
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0002907152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20667Medicare PIN