MEDICARE: BRYAN S SIRES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	00033111	WA

General Provider Information

NPI Number	:	1164443719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN S SIRES MD

Provider Business Mailing Address
First Line	:	625 4TH AVE
Second Line	:	STE 301
City	:	KIRKLAND
State	:	WA
Zip	:	98033-9028
Country	:	US
Telephone Number	:	425-216-7200
Fax Number	:	425-216-7272

Provider Business Practice Location Address
First Line	:	625 4TH AVE
Second Line	:	STE 301
City	:	KIRKLAND
State	:	WA
Zip	:	98033-9028
Country	:	US
Telephone Number	:	425-216-7200
Fax Number	:	425-216-7272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/15/2017

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