Healthcare Provider Details

I. General information

NPI: 1912904046
Provider Name (Legal Business Name): TERRY C MIGDAL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24982 HON AVE
LAGUNA HILLS CA
92653-4302
US

IV. Provider business mailing address

24881 ALICIA PKWY # E516
LAGUNA HILLS CA
92653-4617
US

V. Phone/Fax

Practice location:
  • Phone: 949-716-8613
  • Fax:
Mailing address:
  • Phone: 949-716-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number7013T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: