Provider Demographics
NPI:1356424816
Name:ROY, BRIAN P (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:ROY
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 1:232 ROY RD
Mailing Address - Street 2:
Mailing Address - City:FISKDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-1031
Mailing Address - Country:US
Mailing Address - Phone:508-347-7873
Mailing Address - Fax:
Practice Address - Street 1:5 E MAIN ST
Practice Address - Street 2:
Practice Address - City:W.BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01585
Practice Address - Country:US
Practice Address - Phone:508-867-9076
Practice Address - Fax:508-765-8045
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0304301Medicaid
MAT59162Medicare UPIN
MA0304301Medicaid