Provider Demographics
NPI:1154545481
Name:BRYAN CAVE, O.D.
Entity type:Organization
Organization Name:BRYAN CAVE, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:CAVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:325-573-5571
Mailing Address - Street 1:5305 TRINITY BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-6164
Mailing Address - Country:US
Mailing Address - Phone:325-573-5571
Mailing Address - Fax:325-573-6868
Practice Address - Street 1:5305 TRINITY BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-6164
Practice Address - Country:US
Practice Address - Phone:325-573-5571
Practice Address - Fax:325-573-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3325T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX540010583OtherRAILROAD MEDICARE
TX093269120Medicaid
TX00E50AOtherBLUE CROSS BLUE SHIELD TX
TX110055102OtherFIRST CARE
TX11390OtherOPTICARE
TX093269120Medicaid
TX00E50AOtherBLUE CROSS BLUE SHIELD TX
TXT12586Medicare UPIN