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Individual

MARK L BRYANT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1011 N 4TH ST, CORDELE, GA 31015
(229) 273-0435
Mailing address
216 CORDER RD, WARNER ROBINS, GA 31088-3604
(478) 923-5872
(478) 922-9020

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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