Provider Demographics
NPI:1659453587
Name:INGLE, BRIAN P (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:INGLE
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 1:213 COX CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1572
Mailing Address - Country:US
Mailing Address - Phone:256-760-8072
Mailing Address - Fax:256-718-8499
Practice Address - Street 1:213 COX CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1572
Practice Address - Country:US
Practice Address - Phone:256-760-8072
Practice Address - Fax:256-718-8499
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2010-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-586-TA-222152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALUO1854Medicare UPIN
AL000032944Medicare ID - Type Unspecified