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General NPI Number Information
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NPI Number | 1154545481
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Entity Type | Organization
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Legal Business Name | BRYAN CAVE, O.D.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 01/02/2009
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Provider Practice Location Address
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Address Line | 5305 TRINITY BLVD SUITE D
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City | SNYDER
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State | TX
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Zip | 79549-6164
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Country | US
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Telephone | 325-573-5571
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Fax | 325-573-6868
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Provider Business Mailing Address
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Address Line | 5305 TRINITY BLVD SUITE D
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City | SNYDER
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State | TX
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Zip | 79549-6164
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Country | US
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Telephone | 325-573-5571
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Fax | 325-573-6868
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Authorized Official
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Title or Position | OWNER
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Name | DENNIS BRYAN CAVE
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Credential | O.D.
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Telephone | 325-573-5571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3325T
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License Number State | TX
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