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General NPI Number Information
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NPI Number | 1164505814
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Entity Type | Individual
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Provider Name | MICHELLE XIAOQI MO O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 3904 SMITH ST
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City | UNION CITY
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State | CA
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Zip | 94587-2616
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Country | US
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Telephone | 510-270-5634
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Fax | 510-298-5692
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Provider Business Mailing Address
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Address Line | 38052 CONRAD ST
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City | FREMONT
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State | CA
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Zip | 94536-3924
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Country | US
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Telephone | 510-331-6466
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Fax | 510-713-8510
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11925T
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License Number State | CA
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