Provider Demographics
NPI:1952425811
Name:WEXLER, BRYAN ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ROBERT
Last Name:WEXLER
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 1:3131 N MCMULLEN BOOTH RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2008
Mailing Address - Country:US
Mailing Address - Phone:727-501-7384
Mailing Address - Fax:727-785-9660
Practice Address - Street 1:3131 N MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2008
Practice Address - Country:US
Practice Address - Phone:727-501-7384
Practice Address - Fax:727-785-9660
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL 2808152WC0802X
FLOPC2808152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20593OtherFLORIDA BLUE
FL107605400Medicaid
FL5744494OtherAETNA
FL5186556OtherCIGNA