Provider Demographics
NPI:1245366046
Name:LA MIRADA OPTOMETRY, INC.
Entity type:Organization
Organization Name:LA MIRADA OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-848-0028
Mailing Address - Street 1:12819 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1945
Mailing Address - Country:US
Mailing Address - Phone:562-921-6659
Mailing Address - Fax:
Practice Address - Street 1:12819 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1945
Practice Address - Country:US
Practice Address - Phone:562-921-6659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4891T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty