| |
1428 N Kraemer Blvd, Placentia, CA 92870 | |
(714) 996-1136 | |
(714) 996-0793 |
Full Name | |
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Type | Facility |
Speciality | Eyewear Supplier |
Location | 1428 N Kraemer Blvd, Placentia, California |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1336351998 | NPI | - | NPPES |
SD0094160 7 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152WL0500X | Optometrist - Low Vision Rehabilitation | 9416T (California) | Secondary |
332H00000X | Eyewear Supplier | 9416TPG (California) | Primary |
Provider Name | Michael P De Carlo |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1346327673 PECOS PAC ID: 6406962042 Enrollment ID: I20120306000442 |
Mailing Address | Practice Location Address |
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1428 N Kraemer Blvd, Placentia, CA 92870-3406 Ph: (714) 996-1136 | 1428 N Kraemer Blvd, Placentia, CA 92870 Ph: (714) 996-1136 |