MEDICARE: DR. RORY DRAY BRIENEN 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	OPC2980	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20729	OTHER	FL	BCBS OF FLORIDA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194757377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RORY DRAY BRIENEN O.D.

Provider Business Mailing Address
First Line	:	5435 PARK CENTRAL CT
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-6002
Country	:	US
Telephone Number	:	239-597-1555
Fax Number	:	239-597-3385

Provider Business Practice Location Address
First Line	:	5435 PARK CENTRAL COURT
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-6002
Country	:	US
Telephone Number	:	239-597-1555
Fax Number	:	239-597-3385

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/03/2019

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