Individual provider Active NPI

Michael David Neunzig, O.D.

  • Optometrist
  • Pacific Grove, CA
National Provider Identifier
1083611552
Registry record updated Oct 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT10966TLG Issued in CA
Practice address
505 Lighthouse Ave
Suite 101
Pacific Grove, CA 93950-2750
Phone
(831) 375-5184
Fax
(831) 646-8740
NPI assigned
Jun 30, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 4, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT10966TLG CA Primary

Addresses

Primary practice location

505 Lighthouse Ave
Suite 101
Pacific Grove, CA 93950-2750

Mailing address

505 Lighthouse Ave
Suite 101
Pacific Grove, CA 93950-2750
Phone (831) 375-5184

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050104001019 CA Practitioner - Optometry 9133177330 Practice locations: Hollister, CA; Pacific Grove, CA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

505 Lighthouse Ave
Pacific Grove, CA 93950-2750
Phone (831) 375-5184

891 Sunset Dr
Hollister, CA 95023-5601
Phone (831) 637-7471

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT10966TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Hospital of the Monterey Peninsula Past Accepting new patients
Vantage Eye Center a Medical Corp PastSince Jan 1, 2013 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1083611552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 LIGHTHOUSE AVE",
            "address_2": "SUITE 101",
            "city": "PACIFIC GROVE",
            "state": "CA",
            "postal_code": "939502750",
            "telephone_number": "831-375-5184",
            "fax_number": "831-646-8740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 LIGHTHOUSE AVE",
            "address_2": "SUITE 101",
            "city": "PACIFIC GROVE",
            "state": "CA",
            "postal_code": "939502750",
            "telephone_number": "831-375-5184",
            "fax_number": "831-646-8740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEUNZIG",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT10966TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pacific Grove, CA

Sources for this page

Verify at the official NPI Registry.