Organization
J. MICHAEL VIDAL, OD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. J. MICHAEL VIDAL O.D. (PRESIDENT)
(619) 460-2020
Entity
Organization
Contact information
Practice address
7090 PARKWAY DR, LA MESA, CA 91942-1596
(619) 460-2020
(619) 462-2020
Mailing address
7090 PARKWAY DR, LA MESA, CA 91942-1596
(619) 460-2020
(619) 462-2020
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
CA61320
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0061320
—
CA
Enumeration date
10/27/2009
Last updated
03/08/2011
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