Provider Demographics
NPI:1629036835
Name:BRYANT, ERIC CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CHRISTOPHER
Last Name:BRYANT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1319 MILITARY CUTOFF RD
Mailing Address - Street 2:STE II
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405
Mailing Address - Country:US
Mailing Address - Phone:910-447-2020
Mailing Address - Fax:910-939-1717
Practice Address - Street 1:1031 GRANDIFLORA DR
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7453
Practice Address - Country:US
Practice Address - Phone:910-371-0540
Practice Address - Fax:910-371-2463
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1854152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093NMOtherBCBS PROV #
NCP00476778OtherRR MEDICARE INDIVIDUAL #
NC89093NMMedicaid
NC093NMOtherBCBS PROV #
NC89093NMMedicaid
NC2472470AMedicare PIN
NC2472470BMedicare PIN