Provider Demographics
NPI:1245356682
Name:MACHAMER, BRYAN ALAN (OD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:ALAN
Last Name:MACHAMER
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 1:239 CHESTNUT ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2813
Mailing Address - Country:US
Mailing Address - Phone:215-386-5953
Mailing Address - Fax:215-386-3508
Practice Address - Street 1:3419 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3410
Practice Address - Country:US
Practice Address - Phone:215-386-5953
Practice Address - Fax:215-386-3508
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist