Provider Demographics
NPI:1770577892
Name:ROY, MICHAEL A (O D INC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:ROY
Suffix:
Gender:M
Credentials:O D INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE B103
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3860
Mailing Address - Country:US
Mailing Address - Phone:925-933-4700
Mailing Address - Fax:925-933-4721
Practice Address - Street 1:675 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE B103
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3860
Practice Address - Country:US
Practice Address - Phone:925-933-4700
Practice Address - Fax:925-933-4721
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5326T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMR1264629OtherDEA
CA3879180001Medicare NSC
CAMR1264629OtherDEA
CAU37474Medicare UPIN