Provider Demographics
NPI:1649347337
Name:BUFFO, MICHAEL G (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:BUFFO
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 1:2316 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6653
Mailing Address - Country:US
Mailing Address - Phone:805-482-1299
Mailing Address - Fax:
Practice Address - Street 1:2316 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6653
Practice Address - Country:US
Practice Address - Phone:805-482-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9211T152W00000X, 152WC0802X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44059OtherDAVIS VISION
CABO24396OtherSPECTERA
CACA9211OtherEYEMED
CA200544192OtherTRICARE
CA16361OtherMEDICAL EYE SERVICES
CA8053889500OtherVSP
CAOP9211Medicare ID - Type Unspecified
CABO24396OtherSPECTERA
CACA9211OtherEYEMED