Provider Demographics
NPI:1194336214
Name:FARLEY, BRIANNA (OD)
Entity type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:
Last Name:FARLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COMMERCE PARK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4818
Mailing Address - Country:US
Mailing Address - Phone:704-799-2020
Mailing Address - Fax:704-774-4835
Practice Address - Street 1:125 COMMERCE PARK RD STE 103
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-4818
Practice Address - Country:US
Practice Address - Phone:704-799-2020
Practice Address - Fax:704-774-4835
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist