Provider Demographics
NPI:1740597269
Name:MICHAEL S BOLD OD INC
Entity Type:Organization
Organization Name:MICHAEL S BOLD OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OPTOMETRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BOLD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-995-1144
Mailing Address - Street 1:5422 LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1705
Mailing Address - Country:US
Mailing Address - Phone:714-995-1144
Mailing Address - Fax:714-995-7979
Practice Address - Street 1:5422 LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1705
Practice Address - Country:US
Practice Address - Phone:714-995-1144
Practice Address - Fax:714-995-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT10072 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty