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General NPI Number Information
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NPI Number | 1679678965
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Entity Type | Organization
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Legal Business Name | MICHAEL HERMAN O.D. INC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 02/15/2019
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Provider Practice Location Address
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Address Line | 18203 S WESTERN AVE STE 102
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City | GARDENA
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State | CA
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Zip | 90248
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Country | US
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Telephone | 310-447-4752
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Fax |
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Provider Business Mailing Address
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Address Line | 18203 S WESTERN AVE # 102
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City | GARDENA
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State | CA
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Zip | 90248-3818
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Country | US
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Telephone | 310-447-4752
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Fax | 424-292-3122
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL L HERMAN
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Credential | OPTOMETRIST
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Telephone | 310-447-4752
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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 | CA8247
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License Number State | CA
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