Provider Demographics
NPI:1063934271
Name:FRANTZ, BRYAN JACOB (OD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JACOB
Last Name:FRANTZ
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 1:1220 CROSBY ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-6258
Mailing Address - Country:US
Mailing Address - Phone:937-441-9738
Mailing Address - Fax:
Practice Address - Street 1:946 PEARL RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2562
Practice Address - Country:US
Practice Address - Phone:330-273-1010
Practice Address - Fax:330-225-8115
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHOPT.006717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program