Provider Demographics
NPI:1093076705
Name:BRYAN MA, O.D. OPTOMETRY, INC.
Entity Type:Organization
Organization Name:BRYAN MA, O.D. OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANG KHOA
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-757-2702
Mailing Address - Street 1:2836 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3200
Mailing Address - Country:US
Mailing Address - Phone:714-288-8855
Mailing Address - Fax:714-288-8895
Practice Address - Street 1:2836 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3200
Practice Address - Country:US
Practice Address - Phone:714-288-8855
Practice Address - Fax:714-288-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13525T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGF864BMedicare PIN