Organization
BRYAN D. VANESIAN OD A PROFESSIONAL OPTOMETRY CORPORATION
Active
Parent organization
BRYAN D. VANESIAN OD A PROFESSIONAL OPTOMETRY CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRYAN D. VANESIAN OD A PROFESSIONAL OPTOMETRY CORPORATION
Authorized official
DR. BRYAN DEAN VANESIAN OD (DOCTOR/ OWNER)
(760) 868-2020
Entity
Organization
Contact information
Practice address
4355 PHELAN RD, PHELAN, CA 92371-7675
(760) 868-2020
Mailing address
4355 PHELAN RD, PHELAN, CA 92371-7675
(760) 868-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9375T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0093750
—
CA
Enumeration date
07/07/2008
Last updated
07/09/2008
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