Provider Demographics
NPI:1851381669
Name:GETTIS, MICHAEL WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:GETTIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:8610 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4008
Mailing Address - Country:US
Mailing Address - Phone:310-670-1888
Mailing Address - Fax:310-670-1343
Practice Address - Street 1:8610 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4008
Practice Address - Country:US
Practice Address - Phone:310-670-1888
Practice Address - Fax:310-670-1343
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA4844T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T09796Medicare UPIN
CA0234910001Medicare NSC
CAOP4844Medicare PIN