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General NPI Number Information
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NPI Number | 1326215492
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Entity Type | Organization
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Legal Business Name | MAIN STREET OPTOMETRY
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 1509 N MAIN ST SUITE J
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City | SANTA ANA
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State | CA
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Zip | 92701-7418
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Country | US
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Telephone | 714-542-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 N MAIN ST SUITE J
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City | SANTA ANA
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State | CA
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Zip | 92701-7418
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Country | US
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Telephone | 714-542-2226
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | BRYANT L VO
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Credential | OD
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Telephone | 714-542-2226
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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 | 13286
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License Number State | CA
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