MEDICARE: MICHAEL GRUNING

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	3559TPA	CA

General Provider Information

NPI Number	:	1336266865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GRUNING

Provider Business Mailing Address
First Line	:	1312 MONTANA AVE
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-1710
Country	:	US
Telephone Number	:	310-576-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 MONTANA AVE
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-1710
Country	:	US
Telephone Number	:	310-576-9191
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	10/12/2010

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Directions to “ MICHAEL GRUNING ” Practice Location

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