Provider Demographics
NPI:1275694531
Name:LORAN BRUCE MEBINE
Entity Type:Organization
Organization Name:LORAN BRUCE MEBINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERBAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-664-3089
Mailing Address - Street 1:340 W PORTAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1412
Mailing Address - Country:US
Mailing Address - Phone:415-664-3089
Mailing Address - Fax:415-564-3072
Practice Address - Street 1:340 W PORTAL AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1412
Practice Address - Country:US
Practice Address - Phone:415-664-3089
Practice Address - Fax:415-564-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4991T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSDOOO160Medicaid
CA0234560001Medicare NSC
CASD0126040Medicare PIN
CASD0049910Medicare PIN
V00225Medicare UPIN
CAGSDOOO160Medicaid