Provider Demographics
NPI:1053349803
Name:BRYAN, ADAM B (OD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:B
Last Name:BRYAN
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 1:209 OLIVE FIELD DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-6216
Mailing Address - Country:US
Mailing Address - Phone:919-386-2020
Mailing Address - Fax:
Practice Address - Street 1:316 VILLAGE WALK DRIVE
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7683
Practice Address - Country:US
Practice Address - Phone:919-386-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1992152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902567Medicaid
NC5902567Medicaid
MB1334084OtherDEA
NC2473901AMedicare PIN