Provider Demographics
NPI:1467010173
Name:SOOKOO, BRYAN ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ROBERT
Last Name:SOOKOO
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 1:39 SYLVAN DR
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2113
Mailing Address - Country:US
Mailing Address - Phone:631-398-7059
Mailing Address - Fax:
Practice Address - Street 1:901 BOULEVARD E
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-7511
Practice Address - Country:US
Practice Address - Phone:631-729-4041
Practice Address - Fax:631-205-7157
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist