Provider Demographics
NPI:1396701421
Name:BRYANT, WILLIAM L (OD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:BRYANT
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 1:1100 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4853
Mailing Address - Country:US
Mailing Address - Phone:903-439-2020
Mailing Address - Fax:
Practice Address - Street 1:1100 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4853
Practice Address - Country:US
Practice Address - Phone:903-439-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2422TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410017521OtherRAIL ROAD MEDICARE
TX093246902Medicaid
TX093246904Medicaid
TX80627QOtherBLUE CROSS BLUE SHIELD
TX410017521OtherRAIL ROAD MEDICARE
T12438Medicare UPIN
TX093246904Medicaid