1992018600 NPI number — DR. MICHAEL JOHN ATTEBERRY O.D.

Table of content: DR. MICHAEL JOHN ATTEBERRY O.D. (NPI 1992018600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992018600 NPI number — DR. MICHAEL JOHN ATTEBERRY O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATTEBERRY
Provider First Name:
MICHAEL
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992018600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 BOB BILLINGS PKWY
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66049-4094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-841-2020
Provider Business Mailing Address Fax Number:
785-841-0420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 S IOWA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-841-2020
Provider Business Practice Location Address Fax Number:
785-841-0420
Provider Enumeration Date:
07/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1860 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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