Provider Demographics
NPI:1841334018
Name:KALB, BRYAN E (OD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:E
Last Name:KALB
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 1:10906 BELLE PLAINE BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7113
Mailing Address - Country:US
Mailing Address - Phone:317-577-9247
Mailing Address - Fax:
Practice Address - Street 1:6020 E 82ND ST
Practice Address - Street 2:JCPENNEY OPTICAL
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4746
Practice Address - Country:US
Practice Address - Phone:317-842-2290
Practice Address - Fax:317-842-2290
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001781B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist