Healthcare Provider Details

I. General information

NPI: 1932191483
Provider Name (Legal Business Name): LORAN BRUCE MEBINE JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W PORTAL AVE
SAN FRANCISCO CA
94127-1412
US

IV. Provider business mailing address

340 W PORTAL AVE
SAN FRANCISCO CA
94127-1412
US

V. Phone/Fax

Practice location:
  • Phone: 415-664-3089
  • Fax: 415-564-3072
Mailing address:
  • Phone: 415-664-3089
  • Fax: 415-564-3072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4991T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: