Provider Demographics
NPI:1841344322
Name:FAURIA, MICHAEL FREDRIC (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FREDRIC
Last Name:FAURIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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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
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA8076-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0080760Medicaid
CASD0080760Medicaid
CASD0080760Medicare PIN