Individual
DR. MARK KEVIN BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD-1022
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223434930
TAX IDENTIFICATION NUMBER
NJ
Enumeration date
04/12/2007
Last updated
06/20/2025
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