J. Michael Vidal, OD Inc

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

CA61320 Issued in CA

Legal business name

J. MICHAEL VIDAL, OD INC

Practice address

7090 Parkway Dr
La Mesa, CA 91942-1596

Phone

(619) 460-2020

Fax

(619) 462-2020

NPI assigned

Oct 27, 2009

Last updated

Mar 8, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. J. Michael Vidal, O.D.NPI 1457311128

Title

President

Phone

(619) 460-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• J Michael Vidal, O.D.

  • Optometrist
  • La Mesa, CA
  • NPI 1457311128
  Authorized official Same address or phone

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

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299542400000",
    "number": "1396071296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7090 PARKWAY DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919421596",
            "telephone_number": "619-460-2020",
            "fax_number": "619-462-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7090 PARKWAY DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919421596",
            "telephone_number": "619-460-2020",
            "fax_number": "619-462-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. MICHAEL VIDAL, OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-27",
        "last_updated": "2011-03-08",
        "status": "A",
        "authorized_official_last_name": "VIDAL",
        "authorized_official_first_name": "J. MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-460-2020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "CA61320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0061320",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in La Mesa, CA
• Providers in La Mesa, 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 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.