Provider Demographics
NPI:1912241175
Name:EDWARD G BRYANT IV OD PLLC
Entity Type:Organization
Organization Name:EDWARD G BRYANT IV OD PLLC
Other - Org Name:CLARITY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRYANT IV
Authorized Official - Suffix:IV
Authorized Official - Credentials:OD
Authorized Official - Phone:607-257-1066
Mailing Address - Street 1:1284 DRYDEN ROAD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8795
Mailing Address - Country:US
Mailing Address - Phone:607-257-1066
Mailing Address - Fax:607-257-1378
Practice Address - Street 1:1284 DRYDEN ROAD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-8795
Practice Address - Country:US
Practice Address - Phone:607-257-1066
Practice Address - Fax:607-257-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006637152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty