MEDICARE: DR. DENNIS O'BRYAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2558	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	900B46505	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	DO002558	OTHER	MI	MI LICENCE

General Provider Information

NPI Number	:	1083688162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS O'BRYAN O.D.

Provider Business Mailing Address
First Line	:	8422 M 119
Second Line	:
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-9595
Country	:	US
Telephone Number	:	231-348-1255
Fax Number	:	231-348-3898

Provider Business Practice Location Address
First Line	:	8422 M 119
Second Line	:
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-9595
Country	:	US
Telephone Number	:	231-348-1255
Fax Number	:	231-348-3898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	04/06/2010

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