Provider Demographics
NPI:1457697799
Name:LOMELINO, MICHELE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:LOMELINO
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 1:112 LA CASA VIA
Mailing Address - Street 2:SUITE 260
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3091
Mailing Address - Country:US
Mailing Address - Phone:925-934-6300
Mailing Address - Fax:925-933-9547
Practice Address - Street 1:112 LA CASA VIA
Practice Address - Street 2:SUITE 260
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3091
Practice Address - Country:US
Practice Address - Phone:925-934-6300
Practice Address - Fax:925-933-9547
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist