Provider Demographics
NPI:1659635571
Name:ROOF, BRYAN GRAYSON (OD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:GRAYSON
Last Name:ROOF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:24504 KUYKENDAHL RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3413
Mailing Address - Country:US
Mailing Address - Phone:832-663-0051
Mailing Address - Fax:832-698-4987
Practice Address - Street 1:24504 KUYKENDAHL RD
Practice Address - Street 2:SUITE 500
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3413
Practice Address - Country:US
Practice Address - Phone:832-663-0051
Practice Address - Fax:832-698-4987
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7956TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist