Provider Demographics
NPI:1740344548
Name:BRZYTWA, STEPHEN MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:BRZYTWA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:58 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-5269
Mailing Address - Country:US
Mailing Address - Phone:256-350-7365
Mailing Address - Fax:
Practice Address - Street 1:2620 CENTRON DR SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-2500
Practice Address - Country:US
Practice Address - Phone:256-350-6655
Practice Address - Fax:256-350-2548
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-944-TA-509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALAL0509OtherEYEMED
AL36568-003OtherGE DAVIS
AL222816OtherCOLE VISION LOC. 133157
AL11357OtherSPECTERA
AL2549057OtherUNITED HEALTH CARE
AL515-23772OtherBLUE CROSS & BLUE SHIELD
ALAL0509OtherEYEMED