Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 27OA00540100 | NJ |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 27OA00540100 | NJ |
NPI | 1093939746 |
---|---|
Provider Name | Dr. Mark Kevin Bryant |
First Address | Hoboken, NJ 07030-4832 |
Second Address | Hoboken, NJ 07030-4832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 24/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
223434930 | TAX IDENTIFICATION NUMBER (01) | NJ |