NPIMap

Organization Active NPI

Michaels & Vu OD a Professional Corporation

  • Optometrist
  • Lake Forest, CA
National Provider Identifier
1376748368
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT12615T Issued in CA
Legal business name
MICHAELS & VU OD A PROFESSIONAL CORPORATION
Practice address
23002 Lake Center Dr
Lake Forest, CA 92630-6801
Phone
(949) 454-1064
Fax
(949) 454-4111
NPI assigned
Jun 19, 2007
Organization subpart
Yes
Parent organization
SOUTH COUNTY EYE CARE OPTOMETRIC GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Authorized official

Name
Dr. Justin Michaels, O.D.NPI 1174576904
Title
Ceo
Phone
(949) 454-1064

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X OPT12615T CA Primary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X OPT12669T CA

Addresses

Primary practice location

23002 Lake Center Dr
Lake Forest, CA 92630-6801

Mailing address

23002 Lake Center Dr
Lake Forest, CA 92630-6801
Phone (949) 454-1064

Other names 1

  • South County Eye Care Optometric Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071129000688 CA Part B Supplier - Clinic/Group Practice 8527157437 Receives reassigned benefits from 5 practitioners
Practice locations: La Habra, CA; Lake Forest, CA

National Provider Directory

National Provider Directory
Tax ID family
Michaels and Vu Op Apc2 organizations share this tax ID, including this one
Part of
Kidder and Slosar and

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1400 W Imperial Hwy
Ste J
La Habra, CA 90631
Phone (949) 454-1064

1400 W Imperial Hwy
La Habra, CA 90631

23002 Lake Center Dr
Ste 100
Lake Forest, CA 92630

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1376748368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23002 LAKE CENTER DR",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926306801",
            "telephone_number": "949-454-1064",
            "fax_number": "949-454-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23002 LAKE CENTER DR",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926306801",
            "telephone_number": "949-454-1064",
            "fax_number": "949-454-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAELS & VU OD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH COUNTY EYE CARE OPTOMETRIC GROUP",
        "enumeration_date": "2007-06-19",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "MICHAELS",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-454-1064",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT12615T",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT12669T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South County Eye Care Optometric Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Forest, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.