1841391174 NPI number — MICHAELS OPTICAL INC.

Table of content: YEN KIM LE TRAN (NPI 1457646507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841391174 NPI number — MICHAELS OPTICAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAELS OPTICAL INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841391174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 EL CAMINO REAL
Provider Second Line Business Mailing Address:
B
Provider Business Mailing Address City Name:
ATASCADERO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93422-5358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-466-5770
Provider Business Mailing Address Fax Number:
805-466-5801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8300 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
ATASCADERO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93422-5358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-466-5770
Provider Business Practice Location Address Fax Number:
805-466-5801
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NUTT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
GENE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-466-5770

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  D 3061 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ33213Z . This is a "MEDICAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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