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General NPI Number Information
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NPI Number | 1104078062
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Entity Type | Organization
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Legal Business Name | KIYAN OPTOMETRIC
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 1887 BUSINESS CENTER DR SUITE 2A
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3463
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Country | US
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Telephone | 909-383-1053
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Fax | 909-381-2144
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Provider Business Mailing Address
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Address Line | 1887 BUSINESS CENTER DR SUITE 2A
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3463
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Country | US
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Telephone | 909-383-1053
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Fax | 909-381-2144
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL A KIYAN
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Credential | O.D.
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Telephone | 909-383-1053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 5891T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5891T
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License Number State | CA
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