Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1800X | Optician | D7546 | CA |
Y | 156FX1800X | Optician | SL5833 | CA |
NPI | 1225564784 |
---|---|
Provider Name | Mr. Brian Hyman |
First Address | North Hollywood, CA 91601-2234 |
Second Address | North Hollywood, CA 91601-2234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2017 |
Last Update Date | 03/05/2017 |