Healthcare Provider Details

I. General information

NPI: 1376104190
Provider Name (Legal Business Name): BRIAN DANIEL D'ALLURA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 STATE ROUTE 71
WALL NJ
07719-3153
US

IV. Provider business mailing address

1625 STATE ROUTE 71
WALL NJ
07719-3153
US

V. Phone/Fax

Practice location:
  • Phone: 732-305-0850
  • Fax: 732-305-8340
Mailing address:
  • Phone: 732-305-0850
  • Fax: 732-305-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00689100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00689100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number27OA00689100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: