Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 9416TPG | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 9416TPG | CA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 9416T | CA |
N | 152WX0102X | Occupational Vision | 9416TPG | CA |
NPI | 1346327673 |
---|---|
Provider Name | Dr. Michael P Decarlo |
First Address | Placentia, CA 92870-3406 |
Second Address | Placentia, CA 92870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 17/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0094160 7 | (05) | CA |
U05404 | (02) | CA |