=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710985460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDON DANIEL AYRES MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2005
-----------------------------------------------------
Last Update Date | 11/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 PRESIDENTIAL BLVD STE 200
-----------------------------------------------------
City | BALA CYNWYD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19004-1108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-434-2700
-----------------------------------------------------
Fax | 610-660-0419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 PRESIDENTIAL BLVD STE 200
-----------------------------------------------------
City | BALA CYNWYD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19004-1108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-434-2700
-----------------------------------------------------
Fax | 610-660-0419
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 25MA07879100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD424261
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------