Provider Demographics
NPI:1477696128
Name:BRYLA, CYNTHIA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:BRYLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 OTTAWA DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1666
Mailing Address - Country:US
Mailing Address - Phone:248-828-1934
Mailing Address - Fax:248-828-1934
Practice Address - Street 1:2800 W BIG BEAVER RD
Practice Address - Street 2:N104
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3206
Practice Address - Country:US
Practice Address - Phone:248-649-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004176152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision