Provider Demographics
NPI:1427371897
Name:BRYAN DALE HUSKEY
Entity Type:Organization
Organization Name:BRYAN DALE HUSKEY
Other - Org Name:PROFESSIONAL OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:409-945-7131
Mailing Address - Street 1:2328 PALMER HWY
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-7142
Mailing Address - Country:US
Mailing Address - Phone:409-945-7131
Mailing Address - Fax:409-945-7131
Practice Address - Street 1:2328 PALMER HWY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-7142
Practice Address - Country:US
Practice Address - Phone:409-945-7131
Practice Address - Fax:409-945-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX928908Medicaid
TX928908Medicaid