Provider Demographics
NPI:1528178191
Name:MORRIS, MICHAEL C (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:MORRIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 LAKES DR
Mailing Address - Street 2:STE 180
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2927
Mailing Address - Country:US
Mailing Address - Phone:626-919-4821
Mailing Address - Fax:626-966-2281
Practice Address - Street 1:1000 LAKES DR
Practice Address - Street 2:STE 180
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2927
Practice Address - Country:US
Practice Address - Phone:626-919-4821
Practice Address - Fax:626-966-2281
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5913T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD00059130Medicaid
CAWOP5913AMedicare ID - Type Unspecified
CAT70070Medicare UPIN