Provider Demographics
NPI:1619985264
Name:BRYAN, CONRAD STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:STEPHEN
Last Name:BRYAN
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 1:1000 BRUSHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4459
Mailing Address - Country:US
Mailing Address - Phone:972-401-1546
Mailing Address - Fax:
Practice Address - Street 1:2913 N BELT LINE RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5248
Practice Address - Country:US
Practice Address - Phone:972-570-0981
Practice Address - Fax:972-570-1959
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4065T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19431OtherAVESIS ID
TX16406OtherDAVIS VISION ID
TX43106OtherCLARITY VISION ID
TX910266OtherCOLE MANAGED VISION ID
TX451585OtherNVA ID
TX43106OtherCLARITY VISION ID