Provider Demographics
NPI:1831212075
Name:ROGOFF, BRYAN MICHAEL (OD, MBA, MSC,)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:MICHAEL
Last Name:ROGOFF
Suffix:
Gender:M
Credentials:OD, MBA, MSC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6754 BERNAL AVE STE 740-204
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-1232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6754 BERNAL AVE STE 740-204
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-1232
Practice Address - Country:US
Practice Address - Phone:877-423-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP833152W00000X
MDTA1645152W00000X
IL046-009321152W00000X
CAOPT35348152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist