Provider Demographics
NPI:1396767687
Name:BRINLEY, NOAH DAN (OD)
Entity type:Individual
Prefix:MR
First Name:NOAH
Middle Name:DAN
Last Name:BRINLEY
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 1:37 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4804
Mailing Address - Country:US
Mailing Address - Phone:562-436-6739
Mailing Address - Fax:562-432-6957
Practice Address - Street 1:37 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4804
Practice Address - Country:US
Practice Address - Phone:562-436-6739
Practice Address - Fax:562-432-6957
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11610T152W00000X, 156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WOP11610AMedicare PIN
U88965Medicare UPIN