Healthcare Provider Details

I. General information

NPI: 1952394900
Provider Name (Legal Business Name): MICHAEL JOSEPH ZIRHUT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 FOWLER WAY
PLACERVILLE CA
95667-5740
US

IV. Provider business mailing address

1005 FOWLER WAY
PLACERVILLE CA
95667-5740
US

V. Phone/Fax

Practice location:
  • Phone: 530-295-8001
  • Fax: 530-295-8008
Mailing address:
  • Phone: 530-295-8001
  • Fax: 530-295-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6149T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number6149T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number6149T
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number6149T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: