MEDICARE: DR. BRYAN ALFONSO OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC6595	FL

General Provider Information

NPI Number	:	1346050895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN ALFONSO OD

Provider Business Mailing Address
First Line	:	14748 SW 61ST LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-2403
Country	:	US
Telephone Number	:	786-259-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	8430 MILLS DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4807
Country	:	US
Telephone Number	:	305-279-4260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	01/08/2025

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