Provider Demographics
NPI:1922334382
Name:O'BRYAN EYECARE, P.C.
Entity Type:Organization
Organization Name:O'BRYAN EYECARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:O'BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-364-5800
Mailing Address - Street 1:3120 KARNES RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1319
Mailing Address - Country:US
Mailing Address - Phone:816-364-5800
Mailing Address - Fax:816-364-5806
Practice Address - Street 1:3120 KARNES RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-1319
Practice Address - Country:US
Practice Address - Phone:816-364-5800
Practice Address - Fax:816-364-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU91965Medicare UPIN
Q22C040Medicare PIN