Individual
MARK L BRYANT
Active
Individual
MARK L BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152WX0102X
Occupational Vision Optometrist
Primary
001209
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00415269A
—
GA
01
—
410048938
RR MEDICARE
GA
01
—
483070
AETNA
GA
01
—
538385
BCBS OF GA
GA
Enumeration date
06/13/2005
Last updated
06/13/2018
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