Provider Demographics
NPI:1205953213
Name:MICHAEL F FAURIA OD AND SUSAN M PIRRONE OD A PROFESSIONAL OPTOM
Entity type:Organization
Organization Name:MICHAEL F FAURIA OD AND SUSAN M PIRRONE OD A PROFESSIONAL OPTOM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAURIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-490-0287
Mailing Address - Street 1:194 FRANCISCO LN
Mailing Address - Street 2:SUITE 118
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-8119
Mailing Address - Country:US
Mailing Address - Phone:510-490-0287
Mailing Address - Fax:510-683-8891
Practice Address - Street 1:194 FRANCISCO LN
Practice Address - Street 2:SUITE 118
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-8119
Practice Address - Country:US
Practice Address - Phone:510-490-0287
Practice Address - Fax:510-683-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8076-T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1214460001Medicare NSC
CAZZZ12305ZMedicare ID - Type Unspecified