| Bryan D. Vanesian Od A Professional Optometry Corporation | |
|
4355 Phelan Rd, Phelan, CA 92371-7675 | |
| (760) 868-2020 | |
| Not Available |
| Full Name | Bryan D. Vanesian Od A Professional Optometry Corporation |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 4355 Phelan Rd, Phelan, California |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437312832 | NPI | - | NPPES |
| SD0093750 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 9375T (California) | Primary |
| Provider Name | Bryan D Vanesian |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1346232923 PECOS PAC ID: 8123023959 Enrollment ID: I20060928000465 |
| Provider Name | Dena Thamsopit |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1740410307 PECOS PAC ID: 0143369132 Enrollment ID: I20091204000238 |
| Provider Name | Tom Thamsopit |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1780068726 PECOS PAC ID: 2264741289 Enrollment ID: I20151014000951 |
| Provider Name | Jesse Michael Wetzel |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1811595044 PECOS PAC ID: 1052715166 Enrollment ID: I20210811004300 |
| Provider Name | Michael E Poblete |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1164196820 PECOS PAC ID: 0345474680 Enrollment ID: I20220428001166 |
| Mailing Address | Practice Location Address |
|---|---|
| Bryan D. Vanesian Od A Professional Optometry Corporation 4355 Phelan Rd, Phelan, CA 92371-7675 Ph: (760) 868-2020 | Bryan D. Vanesian Od A Professional Optometry Corporation 4355 Phelan Rd, Phelan, CA 92371-7675 Ph: (760) 868-2020 |
Michael Edward Poblete, OD Optometrist Medicare: Medicare Enrolled Practice Location: 4355 Phelan Rd, Phelan, CA 92371 Phone: 760-868-2020 | |
Dr. Bryan Dean Vanesian, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 4355 Phelan Rd, Phelan, CA 92371 Phone: 760-868-2020 Fax: 760-868-4225 | |
Dr. Dena Thamsopit, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 4355 Phelan Rd, Phelan, CA 92371 Phone: 760-868-2020 Fax: 760-868-7675 | |
Dr. Jesse Michael Wetzel, OD Optometrist Medicare: Medicare Enrolled Practice Location: 4355 Phelan Rd, Phelan, CA 92371 Phone: 760-868-2020 |