Provider Demographics
NPI:1528231065
Name:OTTATI, MICHAEL WILLIAM JR (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:OTTATI
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:3700 SUNSET LN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6199
Mailing Address - Country:US
Mailing Address - Phone:925-757-0450
Mailing Address - Fax:925-757-0266
Practice Address - Street 1:3700 SUNSET LN
Practice Address - Street 2:SUITE 4
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6199
Practice Address - Country:US
Practice Address - Phone:925-757-0450
Practice Address - Fax:925-757-0266
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
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Provider Licenses
StateLicense IDTaxonomies
CA11082TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist