Healthcare Provider Details

I. General information

NPI: 1891604245
Provider Name (Legal Business Name): BRYAN CHARLES LAYTON JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4196 IL-83 N UNIT F
LONG GROVE IL
60047
US

IV. Provider business mailing address

4196 IL-83 N UNIT F
LONG GROVE IL
60047
US

V. Phone/Fax

Practice location:
  • Phone: 847-955-9999
  • Fax:
Mailing address:
  • Phone: 847-955-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046012158
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: