Provider Demographics
NPI:1487845319
Name:BRIGHT, MICHAEL JOSEPH (CPO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CHADBOURNE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9651
Mailing Address - Country:US
Mailing Address - Phone:707-425-5028
Mailing Address - Fax:707-425-5029
Practice Address - Street 1:450 CHADBOURNE RD
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9651
Practice Address - Country:US
Practice Address - Phone:707-425-5028
Practice Address - Fax:707-425-5029
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5887210001Medicare NSC