Provider Demographics
NPI:1164505814
Name:MO, MICHELLE XIAOQI (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:XIAOQI
Last Name:MO
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:38052 CONRAD ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3924
Mailing Address - Country:US
Mailing Address - Phone:510-331-6466
Mailing Address - Fax:510-713-8510
Practice Address - Street 1:3904 SMITH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-2616
Practice Address - Country:US
Practice Address - Phone:510-270-5634
Practice Address - Fax:510-298-5692
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11925T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist