Provider Demographics
NPI:1497837603
Name:JOHN A. FLORYAN, O.D., INC.
Entity Type:Organization
Organization Name:JOHN A. FLORYAN, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FLORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-643-3170
Mailing Address - Street 1:2895 LOMA VISTA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1572
Mailing Address - Country:US
Mailing Address - Phone:805-643-3170
Mailing Address - Fax:805-643-4101
Practice Address - Street 1:2895 LOMA VISTA RD
Practice Address - Street 2:SUITE A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1572
Practice Address - Country:US
Practice Address - Phone:805-643-3170
Practice Address - Fax:805-643-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5389T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0053890Medicaid
CA0542860001Medicare NSC
CAW21365Medicare PIN
CASD0053890Medicaid