Provider Demographics
NPI:1205944121
Name:BRYAN, KAYE C (OD)
Entity type:Individual
Prefix:DR
First Name:KAYE
Middle Name:C
Last Name:BRYAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:K
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2809 OLD DAWSON ROAD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707
Mailing Address - Country:US
Mailing Address - Phone:229-888-3937
Mailing Address - Fax:229-888-6369
Practice Address - Street 1:2809 OLD DAWSON ROAD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:229-888-3937
Practice Address - Fax:229-888-6369
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000621376AMedicaid
GA1255363024OtherOFFICE NPI NUMBER
GA000621376AMedicaid
GA41ZCBWWMedicare ID - Type Unspecified