Provider Demographics
NPI:1326103250
Name:CYPRESS, MICHAEL S (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:CYPRESS
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 1:2926 FLETCHER PKWY
Mailing Address - Street 2:#D
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-2657
Mailing Address - Country:US
Mailing Address - Phone:619-300-2373
Mailing Address - Fax:
Practice Address - Street 1:7007 FRIARS RD
Practice Address - Street 2:#720
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1148
Practice Address - Country:US
Practice Address - Phone:619-683-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7171TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88114Medicare UPIN