Individual
BRYAN ANDREW STAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
905 BEACH BLVD, SUITE B, JACKSONVILLE BEACH, FL 32250-4303
(904) 246-4831
(904) 249-5876
Mailing address
104 NINA CT, PONTE VEDRA BEACH, FL 32082-2429
(904) 273-3149
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 3453
FL
152WV0400X
Vision Therapy Optometrist
OPC 3453
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620556900
—
FL
05
—
620603400
—
FL
Enumeration date
07/19/2005
Last updated
09/14/2007
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