Provider Demographics
NPI:1215096557
Name:HEALEY, BRIAN ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROBERT
Last Name:HEALEY
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 1:330 NICKLAUS CIR
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-5341
Mailing Address - Country:US
Mailing Address - Phone:678-625-7173
Mailing Address - Fax:
Practice Address - Street 1:109 HARMONY XING
Practice Address - Street 2:STE 5
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9525
Practice Address - Country:US
Practice Address - Phone:706-484-2121
Practice Address - Fax:706-484-2148
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist