Provider Demographics
NPI:1538937701
Name:MARKOWITZ, MICHAEL HALL (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HALL
Last Name:MARKOWITZ
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 1:655 BAKER ST APT Q205
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4486
Mailing Address - Country:US
Mailing Address - Phone:417-773-4425
Mailing Address - Fax:
Practice Address - Street 1:4300 LONG BEACH BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2008
Practice Address - Country:US
Practice Address - Phone:156-259-1770
Practice Address - Fax:714-771-7126
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35618152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist