Provider Demographics
NPI:1285619387
Name:DR BRYAN ALING O D P A
Entity type:Organization
Organization Name:DR BRYAN ALING O D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-200-4806
Mailing Address - Street 1:2601 S MILITARY TRL
Mailing Address - Street 2:23
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7510
Mailing Address - Country:US
Mailing Address - Phone:561-433-8448
Mailing Address - Fax:561-433-8313
Practice Address - Street 1:2601 S MILITARY TRL
Practice Address - Street 2:23
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7510
Practice Address - Country:US
Practice Address - Phone:561-433-8448
Practice Address - Fax:561-433-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV02730Medicare UPIN
FLAO313Medicare PIN
FL6167880001Medicare NSC