Basic Information
| Provider Information | |||||||||
| NPI: | 1629036835 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRYANT | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1319 MILITARY CUTOFF RD | ||||||||
| Address2: | STE II | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104472020 | ||||||||
| FaxNumber: | 9109391717 | ||||||||
| Practice Location | |||||||||
| Address1: | 1031 GRANDIFLORA DR | ||||||||
| Address2: | |||||||||
| City: | LELAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284517453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103710540 | ||||||||
| FaxNumber: | 9103712463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 10/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1854 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 093NM | 01 | NC | BCBS PROV # | OTHER | P00476778 | 01 | NC | RR MEDICARE INDIVIDUAL # | OTHER | 89093NM | 05 | NC | MEDICAID |