Provider Demographics
NPI:1831129113
Name:EASLEY, BRIAN F (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:F
Last Name:EASLEY
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 1:6677 W THUNDERBIRD RD
Mailing Address - Street 2:STE B132
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3713
Mailing Address - Country:US
Mailing Address - Phone:602-978-6217
Mailing Address - Fax:623-487-7046
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:STE B132
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3713
Practice Address - Country:US
Practice Address - Phone:602-978-6217
Practice Address - Fax:623-487-7046
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ346152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ79761Medicare ID - Type Unspecified
AZT41574Medicare UPIN