Provider Demographics
NPI:1740398296
Name:MICHELSEN, VIYADA JOY (OD)
Entity Type:Individual
Prefix:DR
First Name:VIYADA
Middle Name:JOY
Last Name:MICHELSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 OLD 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-2055
Mailing Address - Country:US
Mailing Address - Phone:925-449-8188
Mailing Address - Fax:925-449-1818
Practice Address - Street 1:2580 OLD 1ST ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-2055
Practice Address - Country:US
Practice Address - Phone:510-847-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist