Provider Demographics
NPI:1104022110
Name:SUTTON, MICHAEL DOUGLAS (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:SUTTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2203 LOVERIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5021
Mailing Address - Country:US
Mailing Address - Phone:925-252-1829
Mailing Address - Fax:925-427-5127
Practice Address - Street 1:2203 LOVERIDGE ROAD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5021
Practice Address - Country:US
Practice Address - Phone:925-252-1829
Practice Address - Fax:925-427-5127
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13917 TPL152W00000X
FL4069152W00000X
CA13917TPL152W00000X
FLOPC4069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist