MEDICARE: JOANNE BRILLIANT O.D., P.A.

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

General Provider Information

NPI Number	:	1144403098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNE BRILLIANT O.D., P.A.

Provider Business Mailing Address
First Line	:	1410 FOREST DR
Second Line	:	SUITE 1
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-1442
Country	:	US
Telephone Number	:	410-295-3010
Fax Number	:	410-295-3015

Provider Business Practice Location Address
First Line	:	1410 FOREST DR
Second Line	:	SUITE 1
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-1442
Country	:	US
Telephone Number	:	410-295-3010
Fax Number	:	410-295-3015

Authorized Official
Title or Position	:	DR. OF OPTOMETRY
Name	:	DR. JO ANNE BRILLIANT
Credential	:	O.D.
Telephone Number	:	410-295-3010

Provider Enumeration Date	:	12/14/2007
Last Update Date	:	11/01/2023

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