Provider Demographics
NPI:1700166766
Name:PAULS, BRYAN G
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:G
Last Name:PAULS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BRYAN
Other - Middle Name:G
Other - Last Name:PAULS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 207293
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7293
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:800 N 4TH ST STE 102
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KS
Practice Address - Zip Code:66839-2618
Practice Address - Country:US
Practice Address - Phone:620-364-2134
Practice Address - Fax:620-364-5477
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1899152W00000X
TX7843T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist