MEDICARE: MICHAEL XU 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	0618001211	VA

General Provider Information

NPI Number	:	1578626404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL XU O.D.

Provider Business Mailing Address
First Line	:	PO BOX 9817
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23450-9817
Country	:	US
Telephone Number	:	757-480-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1149 NIMMO PKWY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7730
Country	:	US
Telephone Number	:	757-480-5005
Fax Number	:

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/20/2022

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