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NPI Code Detail

MEDICARE: DR. MARK RUDOLPH BISSON O.D.

MEDICARE: DR. MARK RUDOLPH BISSON O.D.
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
1152W00000XOptometrist9206CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457326217
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK RUDOLPH BISSON O.D.
Provider Business Mailing Address
First Line : 328 REDONDO AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90814-2651
Country : US
Telephone Number : 562-439-0486
Fax Number : 562-987-3596
Provider Business Practice Location Address
First Line : 328 REDONDO AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90814-2651
Country : US
Telephone Number : 562-439-0486
Fax Number : 562-987-3596
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 12/02/2015

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