Provider Demographics
NPI:1730769332
Name:RUNK, BRIAN SCOTT (COMS, CLVT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:RUNK
Suffix:
Gender:M
Credentials:COMS, CLVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 SW 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7843
Mailing Address - Country:US
Mailing Address - Phone:352-861-3961
Mailing Address - Fax:352-861-3941
Practice Address - Street 1:3307 SW 26TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7843
Practice Address - Country:US
Practice Address - Phone:352-861-3940
Practice Address - Fax:352-861-3941
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
63022255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind