Provider Demographics
NPI:1952394900
Name:ZIRHUT, MICHAEL JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:ZIRHUT
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 1:1005 FOWLER WAY
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5740
Mailing Address - Country:US
Mailing Address - Phone:530-295-8001
Mailing Address - Fax:530-295-8008
Practice Address - Street 1:1005 FOWLER WAY
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5740
Practice Address - Country:US
Practice Address - Phone:530-295-8001
Practice Address - Fax:530-295-8008
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6149T152W00000X, 152WC0802X, 152WL0500X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0061490Medicaid
CA1952394900OtherNATIONAL PROVIDER IDENTIFIER
CASD0061490Medicaid
CASD0061490Medicare PIN