MEDICARE: DR. ERIC CHRISTOPHER BRYANT OD

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	1854	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00476778	OTHER	NC	RR MEDICARE INDIVIDUAL #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	093NM	OTHER	NC	BCBS PROV #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629036835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC CHRISTOPHER BRYANT OD

Provider Business Mailing Address
First Line	:	1319 MILITARY CUTOFF RD
Second Line	:	STE II
City	:	WILMINGTON
State	:	NC
Zip	:	28405
Country	:	US
Telephone Number	:	910-447-2020
Fax Number	:	910-939-1717

Provider Business Practice Location Address
First Line	:	1031 GRANDIFLORA DR
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-7453
Country	:	US
Telephone Number	:	910-371-0540
Fax Number	:	910-371-2463

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	10/23/2015

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