Provider Demographics
NPI:1750369641
Name:HERMAN, MICHAEL LANCE (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LANCE
Last Name:HERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18203 S WESTERN AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90248
Mailing Address - Country:US
Mailing Address - Phone:310-447-4752
Mailing Address - Fax:
Practice Address - Street 1:2524 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2549
Practice Address - Country:US
Practice Address - Phone:213-749-3888
Practice Address - Fax:213-747-8670
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8247T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954814055OtherBLUE CROSS CALIFORNIA
CASD08247T0OtherBLUE SHIELD CALIFORNIA
CASD0082470Medicaid
CA954814055OtherBLUE CROSS CALIFORNIA
V08238Medicare UPIN