Healthcare Provider Details

I. General information

NPI: 1710985460
Provider Name (Legal Business Name): BRANDON DANIEL AYRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PRESIDENTIAL BLVD STE 200
BALA CYNWYD PA
19004-1108
US

IV. Provider business mailing address

100 PRESIDENTIAL BLVD STE 200
BALA CYNWYD PA
19004-1108
US

V. Phone/Fax

Practice location:
  • Phone: 484-434-2700
  • Fax: 610-660-0419
Mailing address:
  • Phone: 484-434-2700
  • Fax: 610-660-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA07879100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD424261
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: