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General NPI Number Information
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NPI Number | 1114160892
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Entity Type | Organization
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Legal Business Name | FIRST BRISTOL OPTOMETRY
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Dates
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Enumeration Date | 04/11/2009
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Last Update Date | 04/11/2009
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Provider Practice Location Address
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Address Line | 1601 W 1ST ST SUITE C
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City | SANTA ANA
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State | CA
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Zip | 92703-3670
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Country | US
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Telephone | 714-543-7072
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Fax | 714-543-7073
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Provider Business Mailing Address
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Address Line | 1601 W 1ST ST SUITE C
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City | SANTA ANA
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State | CA
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Zip | 92703-3670
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Country | US
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Telephone | 714-543-7072
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Fax | 714-543-7073
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MIMI K TRAN
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Credential | O.D.
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Telephone | 714-889-0688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | OPT 13598T
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License Number State | CA
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