Michael P de Carlo Optometrist Inc

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

9416TPG Issued in CA

Legal business name

MICHAEL P DE CARLO OPTOMETRIST INC

Practice address

1428 N Kraemer Blvd
Placentia, CA 92870

Phone

(714) 996-1136

Fax

(714) 996-0793

NPI assigned

May 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael P Decarlo, O.D.NPI 1346327673

Title

President

Phone

(562) 881-2454

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Michael P. DeCarlo Optometrist, Inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael P Decarlo, O.D.

  • Optometrist
  • Placentia, CA
  • NPI 1346327673
  Medicare reassignment Authorized official
• Jesus Ramon Merino, O.D.

  • Optometrist
  • Paramount, CA
  • NPI 1609130624
  NPD (past)
• Tania Stevens, O.D.

  • Optometrist
  • Long Beach, CA
  • NPI 1427089630

  Low Vision Rehabilitation

  NPD (past)

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677801600000",
    "number": "1336351998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1428 N KRAEMER BLVD",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928703406",
            "telephone_number": "714-996-1136",
            "fax_number": "714-996-0793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1428 N KRAEMER BLVD",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "92870",
            "telephone_number": "714-996-1136",
            "fax_number": "714-996-0793"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5724 E 7th St",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908032002",
            "country_code": "US",
            "telephone_number": "562-986-6373",
            "fax_number": "562-986-6377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MICHAEL P DE CARLO OPTOMETRIST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2023-03-03",
        "certification_date": "2023-02-08",
        "status": "A",
        "authorized_official_last_name": "DECARLO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-881-2454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152WL0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "CA",
            "license": "9416T",
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "9416TPG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0094160 7",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael P. DeCarlo Optometrist, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brisa Mendoza
• Shirley Pujol Merioles, PT
• Michelle Meyerson
• Michael H. Macalalad, DDS Inc.
• Michael Liu M.D.
• Gretchen Nicole Michalik
• Aimee Mikalinis
• Kimiko P Miller, PA-C
• Stacey Anderson Miller, MA-CCCSP
• Alanna Michelle Mills

• Eyewear Supplier in Placentia, CA
• Providers in Placentia, CA by specialty
• Eyewear Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.