Provider Demographics
NPI:1558986596
Name:BUCKLEY, BRIANNA (OD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:BUCKLEY
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 1:2212 MIFFLIN AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-8846
Mailing Address - Country:US
Mailing Address - Phone:419-289-0808
Mailing Address - Fax:419-281-1200
Practice Address - Street 1:2212 MIFFLIN AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8848
Practice Address - Country:US
Practice Address - Phone:419-289-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006888152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist