Healthcare Provider Details

I. General information

NPI: 1366749459
Provider Name (Legal Business Name): MICHAEL A. ROY, O.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 YGNACIO VALLEY RD SUITE B103
WALNUT CREEK CA
94596-3860
US

IV. Provider business mailing address

675 YGNACIO VALLEY RD SUITE B103
WALNUT CREEK CA
94596-3860
US

V. Phone/Fax

Practice location:
  • Phone: 925-933-4700
  • Fax: 925-933-4721
Mailing address:
  • Phone: 925-933-4700
  • Fax: 925-933-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number5326T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ALFRED ROY
Title or Position: OWNER
Credential: O.D.
Phone: 925-933-4700