Provider Demographics
NPI:1851928063
Name:BRYAN J MIRONE OPTOMETRIC INC
Entity Type:Organization
Organization Name:BRYAN J MIRONE OPTOMETRIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MIRONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-901-9644
Mailing Address - Street 1:4000 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3458
Mailing Address - Country:US
Mailing Address - Phone:951-687-7100
Mailing Address - Fax:951-687-1663
Practice Address - Street 1:4000 TYLER ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3458
Practice Address - Country:US
Practice Address - Phone:951-687-7100
Practice Address - Fax:951-687-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty