Provider Demographics
NPI:1891108825
Name:THORSEN, BRYAN R (OD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:R
Last Name:THORSEN
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 1:6000 OGEECHEE RD
Mailing Address - Street 2:VISION CENTER IN WALMART
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9544
Mailing Address - Country:US
Mailing Address - Phone:912-920-3255
Mailing Address - Fax:
Practice Address - Street 1:6000 OGEECHEE RD
Practice Address - Street 2:VISION CENTER IN WALMART
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9544
Practice Address - Country:US
Practice Address - Phone:912-920-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist