Provider Demographics
NPI:1558410647
Name:TIERNAN OPTICIANS,INC.
Entity Type:Organization
Organization Name:TIERNAN OPTICIANS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:650-592-1666
Mailing Address - Street 1:1225 SAN CARLOS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2419
Mailing Address - Country:US
Mailing Address - Phone:650-592-1666
Mailing Address - Fax:650-592-1725
Practice Address - Street 1:1225 SAN CARLOS AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2419
Practice Address - Country:US
Practice Address - Phone:650-592-1666
Practice Address - Fax:650-592-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD2913332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0213540001Medicare NSC