MEDICARE: DR. MICHAEL JAMES LUM OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	34248TLG	CA

General Provider Information

NPI Number	:	1215589049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JAMES LUM OD

Provider Business Mailing Address
First Line	:	17 VIA DE LA MESA
Second Line	:
City	:	RSM
State	:	CA
Zip	:	92688-1318
Country	:	US
Telephone Number	:	949-632-2309
Fax Number	:

Provider Business Practice Location Address
First Line	:	25260 LA PAZ RD
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5132
Country	:	US
Telephone Number	:	949-878-9724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	07/10/2024

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