Physician Compare National (NPI:1164494423)

HEALTHCARE PROVIDER: BRIAN WAYNE CANNON O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1164494423
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9830227255
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100913000980
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CANNON
	Individual professional last name
Provider First Name	BRIAN
	Individual professional first name
Provider Middle Name	WAYNE
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY ALABAMA BIRMINGHAM - SCHOOL OF OPTOMETRY
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	DRS EYECARE INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	1456349448
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	7323 COLLEGE ST
	Group Practice or individual's line 1 address
City	IRMO
	Group Practice or individual's city
State	SC
	Group Practice or individual's state
Zip Code	290632902
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8037506600
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y