Provider Demographics
NPI:1386902385
Name:MARK K. BRYANT
Entity type:Organization
Organization Name:MARK K. BRYANT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-581-1232
Mailing Address - Street 1:311 W 43RD ST STE 1405
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6447
Mailing Address - Country:US
Mailing Address - Phone:212-581-1232
Mailing Address - Fax:212-581-5059
Practice Address - Street 1:311 W 43RD ST STE 1405
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6447
Practice Address - Country:US
Practice Address - Phone:212-581-1232
Practice Address - Fax:212-581-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005628-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1093939746OtherNPI