NPIMap

Organization Active NPI

Bryan D. Vanesian OD a Professional Optometry Corporation

  • Optometrist
  • Phelan, CA
National Provider Identifier
1437312832
Registry record updated Jul 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9375T Issued in CA
Legal business name
BRYAN D. VANESIAN OD A PROFESSIONAL OPTOMETRY CORPORATION
Practice address
4355 Phelan Rd
Phelan, CA 92371-7675
Phone
(760) 868-2020
NPI assigned
Jul 7, 2008
Last updated
Jul 9, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
BRYAN D. VANESIAN OD A PROFESSIONAL OPTOMETRY CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bryan Dean Vanesian, ODNPI 1346232923
Title
Doctor/ Owner
Phone
(760) 868-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 9375T CA Primary

Addresses

Primary practice location

4355 Phelan Rd
Phelan, CA 92371-7675

Mailing address

4355 Phelan Rd
Phelan, CA 92371-7675
Phone (760) 868-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081113000024 CA Part B Supplier - Clinic/Group Practice 4880753359 Receives reassigned benefits from 6 practitioners
Practice locations: Adelanto, CA; Apple Valley, CA; Phelan, CA

National Provider Directory

National Provider Directory
Part of
Bryan D Vanesian OD a Poc

Locations

12100 Palmdale Rd
Ste B10
Adelanto, CA 92301
Phone (760) 246-2002

13692 Apple Valley Rd
Ste 180
Apple Valley, CA 92308
Phone (760) 961-1919

4355 Phelan Rd
Phelan, CA 92371
Phone (760) 868-2020

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215561600000",
    "number": "1437312832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4355 PHELAN RD",
            "city": "PHELAN",
            "state": "CA",
            "postal_code": "923717675",
            "telephone_number": "760-868-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4355 PHELAN RD",
            "city": "PHELAN",
            "state": "CA",
            "postal_code": "923717675",
            "telephone_number": "760-868-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN D. VANESIAN OD A PROFESSIONAL OPTOMETRY CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRYAN D. VANESIAN OD A PROFESSIONAL OPTOMETRY CORPORATION",
        "enumeration_date": "2008-07-07",
        "last_updated": "2008-07-09",
        "status": "A",
        "authorized_official_last_name": "VANESIAN",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "DOCTOR/ OWNER",
        "authorized_official_telephone_number": "760-868-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9375T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phelan, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.