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General NPI Number Information
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NPI Number | 1356756464
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Entity Type | Organization
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Legal Business Name | ACCUVISION EYECARE OPTOMETRY
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 2580 OLD 1ST ST
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City | LIVERMORE
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State | CA
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Zip | 94550-2055
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Country | US
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Telephone | 925-449-8188
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Fax | 925-449-1818
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Provider Business Mailing Address
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Address Line | 2580 OLD 1ST ST
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City | LIVERMORE
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State | CA
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Zip | 94550-2055
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Country | US
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Telephone | 925-449-8188
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Fax | 925-449-1818
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. RICHARD J MICHELSEN
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Credential | OD
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Telephone | 925-449-8188
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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 | 13138T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13574TLG
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License Number State | CA
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