Healthcare Provider Details

I. General information

NPI: 1992914865
Provider Name (Legal Business Name): MICHAEL MORRIS OD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N AZUSA AVE
AZUSA CA
91702-2910
US

IV. Provider business mailing address

631 N AZUSA AVE
AZUSA CA
91702-2910
US

V. Phone/Fax

Practice location:
  • Phone: 626-919-4821
  • Fax: 626-917-8439
Mailing address:
  • Phone: 626-919-4821
  • Fax: 626-917-8439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL C MORRIS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 626-919-4821