Provider Demographics
NPI:1083611552
Name:NEUNZIG, MICHAEL DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:NEUNZIG
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:505 LIGHTHOUSE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2750
Mailing Address - Country:US
Mailing Address - Phone:831-375-5184
Mailing Address - Fax:831-646-8740
Practice Address - Street 1:505 LIGHTHOUSE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2750
Practice Address - Country:US
Practice Address - Phone:831-375-5184
Practice Address - Fax:831-646-8740
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT10966TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU80306Medicare UPIN