Healthcare Provider Details

I. General information

NPI: 1548379613
Provider Name (Legal Business Name): MICHAEL ANTHONY SANTARLAS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 ISLAND AVE UNIT 503
SAN DIEGO CA
92101-6898
US

IV. Provider business mailing address

221 ISLAND AVE UNIT 503
SAN DIEGO CA
92101-6898
US

V. Phone/Fax

Practice location:
  • Phone: 199-953-9376
  • Fax:
Mailing address:
  • Phone: 199-953-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13241TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046009527
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: