Provider Demographics
NPI:1225564784
Name:HYMAN, BRIAN (SLD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:HYMAN
Suffix:
Gender:M
Credentials:SLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10523 BURBANK BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2234
Mailing Address - Country:US
Mailing Address - Phone:818-760-5262
Mailing Address - Fax:818-232-7041
Practice Address - Street 1:10523 BURBANK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2234
Practice Address - Country:US
Practice Address - Phone:818-760-5262
Practice Address - Fax:818-232-7041
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL5833156FX1800X
CAD7546156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician