Provider Demographics
NPI:1447301528
Name:GOLITZ, MICHAEL A (OD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:GOLITZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5422
Mailing Address - Country:US
Mailing Address - Phone:425-822-8204
Mailing Address - Fax:425-822-8001
Practice Address - Street 1:601 MARKET ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5422
Practice Address - Country:US
Practice Address - Phone:425-822-8204
Practice Address - Fax:425-822-8001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA1818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT90717Medicare UPIN