Provider Demographics
NPI:1205558988
Name:OLMEDO, MIGUEL (OD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:OLMEDO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7862 BARBI LN
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1603
Mailing Address - Country:US
Mailing Address - Phone:562-405-7309
Mailing Address - Fax:
Practice Address - Street 1:7862 BARBI LN
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1603
Practice Address - Country:US
Practice Address - Phone:562-405-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist