Provider Demographics
NPI:1023265196
Name:BRYAN TOTAL VISION CARE
Entity type:Organization
Organization Name:BRYAN TOTAL VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:VANLANINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:979-774-5400
Mailing Address - Street 1:2200 BRIARCREST DR
Mailing Address - Street 2:STE 106
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5001
Mailing Address - Country:US
Mailing Address - Phone:979-774-5400
Mailing Address - Fax:979-731-8483
Practice Address - Street 1:2200 BRIARCREST DR
Practice Address - Street 2:STE 106
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5001
Practice Address - Country:US
Practice Address - Phone:979-774-5400
Practice Address - Fax:979-731-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152W00000X
TX5627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156519401Medicaid
TXTXB149186Medicare UPIN