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General NPI Number Information
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NPI Number | 1336351998
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Entity Type | Organization
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Legal Business Name | MICHAEL P DE CARLO OPTOMETRIST INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 1428 N KRAEMER BLVD
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City | PLACENTIA
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State | CA
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Zip | 92870
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Country | US
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Telephone | 714-996-1136
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Fax | 714-996-0793
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Provider Business Mailing Address
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Address Line | 1428 N KRAEMER BLVD
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City | PLACENTIA
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State | CA
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Zip | 92870-3406
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Country | US
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Telephone | 714-996-1136
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Fax | 714-996-0793
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL P DECARLO
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Credential | O.D.
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Telephone | 562-881-2454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 9416T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 9416TPG
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License Number State | CA
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