Provider Demographics
NPI:1164443719
Name:SIRES, BRYAN S (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:S
Last Name:SIRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 4TH AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-9028
Mailing Address - Country:US
Mailing Address - Phone:425-216-7200
Mailing Address - Fax:425-216-7272
Practice Address - Street 1:625 4TH AVE
Practice Address - Street 2:STE 301
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-9028
Practice Address - Country:US
Practice Address - Phone:425-216-7200
Practice Address - Fax:425-216-7272
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00033111207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8859151Medicare ID - Type Unspecified