Individual
DR. J MICHAEL VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
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
152W00000X
Optometrist
Primary
CA61320
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0061320
—
CA
Enumeration date
03/25/2006
Last updated
02/11/2014
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