Provider Demographics
NPI:1205415627
Name:PROCOPIO, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:PROCOPIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 OLD KEENE MILL RD
Mailing Address - Street 2:STE A
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4284
Mailing Address - Country:US
Mailing Address - Phone:703-569-3131
Mailing Address - Fax:
Practice Address - Street 1:9314 OLD KEENE MILL RD STE A
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4284
Practice Address - Country:US
Practice Address - Phone:703-569-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-04
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003020152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist