Individual
MR. RYAN WAYNE BRACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
24833 JOHN T REID PKWY, SCOTTSBORO, AL 35768-2340
(256) 574-5698
(256) 574-6939
Mailing address
178 TAMMY GAINES LN, HUNTSVILLE, AL 35811-8951
(256) 746-0170
(256) 574-6939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S975TA537
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51503656
BCBS OF AL
AL
Enumeration date
09/17/2006
Last updated
07/08/2007
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