MEDICARE: DR. MICHAEL DAVID NEUNZIG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT10966TLG	CA

General Provider Information

NPI Number	:	1083611552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DAVID NEUNZIG O.D.

Provider Business Mailing Address
First Line	:	505 LIGHTHOUSE AVE
Second Line	:	SUITE 101
City	:	PACIFIC GROVE
State	:	CA
Zip	:	93950-2750
Country	:	US
Telephone Number	:	831-375-5184
Fax Number	:	831-646-8740

Provider Business Practice Location Address
First Line	:	505 LIGHTHOUSE AVE
Second Line	:	SUITE 101
City	:	PACIFIC GROVE
State	:	CA
Zip	:	93950-2750
Country	:	US
Telephone Number	:	831-375-5184
Fax Number	:	831-646-8740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/04/2018

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