Provider Demographics
NPI:1073572806
Name:LOCKHART, MICHAEL JR (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LOCKHART
Suffix:JR
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 1:1151 MELSCHEIMER RD SW
Mailing Address - Street 2:
Mailing Address - City:EAST SPARTA
Mailing Address - State:OH
Mailing Address - Zip Code:44626-9752
Mailing Address - Country:US
Mailing Address - Phone:330-484-3203
Mailing Address - Fax:
Practice Address - Street 1:915 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-6833
Practice Address - Country:US
Practice Address - Phone:330-833-1091
Practice Address - Fax:330-833-1092
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2642439Medicaid
OH4180641Medicare PIN