Provider Demographics
NPI:1003931346
Name:SPITZER, MICHAEL N (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:N
Last Name:SPITZER
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 1:2646 DUPONT DR.
Mailing Address - Street 2:#240
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612
Mailing Address - Country:US
Mailing Address - Phone:949-955-3937
Mailing Address - Fax:949-955-3937
Practice Address - Street 1:2646 DUPONT DR STE 240
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1689
Practice Address - Country:US
Practice Address - Phone:949-955-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7064T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist