Provider Demographics
NPI:1871761197
Name:ALING, BRYAN (OD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:ALING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 S MILITARY TRL
Mailing Address - Street 2:23
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7510
Mailing Address - Country:US
Mailing Address - Phone:561-433-8448
Mailing Address - Fax:561-433-8313
Practice Address - Street 1:2601 S MILITARY TRL
Practice Address - Street 2:23
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7510
Practice Address - Country:US
Practice Address - Phone:561-433-8448
Practice Address - Fax:561-433-8313
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620989100Medicaid
FLU3941ZMedicare PIN
FL620989100Medicaid