Provider Demographics
NPI:1376748368
Name:MICHAELS & VU OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAELS & VU OD A PROFESSIONAL CORPORATION
Other - Org Name:SOUTH COUNTY EYE CARE OPTOMETRIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-454-1064
Mailing Address - Street 1:23002 LAKE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-6801
Mailing Address - Country:US
Mailing Address - Phone:949-454-1064
Mailing Address - Fax:949-454-4111
Practice Address - Street 1:23002 LAKE CENTER DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-6801
Practice Address - Country:US
Practice Address - Phone:949-454-1064
Practice Address - Fax:949-454-4111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH COUNTY EYE CARE OPTOMETRIC GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-19
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12615T152W00000X
CAOPT12669T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty