Provider Demographics
NPI:1811199730
Name:BRYANT, LARRY P (OPTICAN)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:P
Last Name:BRYANT
Suffix:
Gender:M
Credentials:OPTICAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MCCALAHAN
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022
Mailing Address - Country:US
Mailing Address - Phone:501-847-7929
Mailing Address - Fax:501-847-3318
Practice Address - Street 1:212 MCCALAHAN
Practice Address - Street 2:SUITE C
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022
Practice Address - Country:US
Practice Address - Phone:501-847-7929
Practice Address - Fax:501-847-3318
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL930718156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician