Provider Demographics
NPI:1366749459
Name:MICHAEL A. ROY, O.D. INC.
Entity type:Organization
Organization Name:MICHAEL A. ROY, O.D. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-933-4700
Mailing Address - Street 1:675 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE B103
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3860
Mailing Address - Country:US
Mailing Address - Phone:925-933-4700
Mailing Address - Fax:925-933-4721
Practice Address - Street 1:675 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE B103
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3860
Practice Address - Country:US
Practice Address - Phone:925-933-4700
Practice Address - Fax:925-933-4721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CA5326T261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3879180001Medicare NSC
CAER668ZMedicare PIN