Healthcare Provider Details

I. General information

NPI: 1366428120
Provider Name (Legal Business Name): RICHARD G BRYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DUDLEY ST SUITE 303
PROVIDENCE RI
02905-2436
US

IV. Provider business mailing address

120 DUDLEY ST SUITE 303
PROVIDENCE RI
02905-2436
US

V. Phone/Fax

Practice location:
  • Phone: 401-369-7773
  • Fax: 401-369-7336
Mailing address:
  • Phone: 401-369-7773
  • Fax: 401-369-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD11942
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number225844
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD11942
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number225844
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: