Provider Demographics
NPI:1104906387
Name:KIRALY, BRUCE A (OD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:KIRALY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2201
Mailing Address - Country:US
Mailing Address - Phone:804-358-8443
Mailing Address - Fax:804-358-1395
Practice Address - Street 1:14431 SOMMERVILLE CT
Practice Address - Street 2:STE B
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6812
Practice Address - Country:US
Practice Address - Phone:804-888-8998
Practice Address - Fax:804-888-8999
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT21832Medicare UPIN
VA410031629Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA410000847Medicare ID - Type Unspecified