Provider Demographics
NPI:1346050895
Name:ALFONSO, BRYAN (OD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:ALFONSO
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 1:14748 SW 61ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2403
Mailing Address - Country:US
Mailing Address - Phone:786-259-7005
Mailing Address - Fax:
Practice Address - Street 1:8430 MILLS DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4807
Practice Address - Country:US
Practice Address - Phone:305-279-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist