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General NPI Number Information
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NPI Number | 1407002942
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Entity Type | Organization
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Legal Business Name | MICHAEL J. PROIETTE O.D., INC.
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 61 LINCOLN BLVD STE A
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City | LINCOLN
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State | CA
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Zip | 95648-6310
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Country | US
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Telephone | 916-408-0103
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Fax | 916-408-0117
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Provider Business Mailing Address
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Address Line | 61 LINCOLN BLVD STE A
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City | LINCOLN
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State | CA
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Zip | 95648-6310
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Country | US
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Telephone | 916-408-0103
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Fax | 916-408-0117
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. MICHAEL J PROIETTE
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Credential | O.D.
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Telephone | 916-408-0103
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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 | OPT9339T
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License Number State | CA
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