Provider Demographics
NPI:1528599487
Name:YOUNG, BRYAN ROMAR (LDO)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ROMAR
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-4452
Mailing Address - Country:US
Mailing Address - Phone:561-667-3400
Mailing Address - Fax:
Practice Address - Street 1:411 W 27TH ST
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4452
Practice Address - Country:US
Practice Address - Phone:561-667-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6961156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician