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General NPI Number Information
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NPI Number | 1265895221
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Entity Type | Organization
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Legal Business Name | MIRA MESA OPTOMETRY, INC
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 8230 MIRA MESA BLVD STE B
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City | SAN DIEGO
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State | CA
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Zip | 92126-2625
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Country | US
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Telephone | 858-566-6670
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Fax | 858-566-5152
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Provider Business Mailing Address
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Address Line | 8230 MIRA MESA BLVD STE B
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City | SAN DIEGO
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State | CA
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Zip | 92126-2625
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Country | US
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Telephone | 858-566-6670
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Fax | 858-566-5152
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ORLANDO GUIANG
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Credential |
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Telephone | 858-566-6670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9901
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License Number State | CA
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