Stam, Bryan Andrew

Stam, Bryan Andrew is an individual health care provider with primary practice located at 905 Beach Blvd Suite B, Jacksonville Beach FL 32250-4303. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Vision Therapy. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Stam, Bryan Andrew can be contacted via phone (904) 246-4831.

Contact Information

Primary practice address
905 Beach Blvd Suite B Jacksonville Beach FL 32250-4303
Phone: (904) 246-4831
Fax: (904) 249-5876
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X OPC 3453 Florida
Eye and Vision Services Providers / Vision Therapy 152WV0400X OPC 3453 Florida

Profile Details

NPI number 1245239581
LBN Legal business name Stam, Bryan Andrew
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2005
Last updated Sep 14th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245239581 NPPES
Florida MEDICAID 620556900
Florida MEDICAID 620603400

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