Provider Demographics
NPI:1124004809
Name:TINKELMAN, MICHAEL D (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:TINKELMAN
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 1:104 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1347
Mailing Address - Country:US
Mailing Address - Phone:814-466-2020
Mailing Address - Fax:814-808-6165
Practice Address - Street 1:104 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOALSBURG
Practice Address - State:PA
Practice Address - Zip Code:16827-1347
Practice Address - Country:US
Practice Address - Phone:814-466-2020
Practice Address - Fax:814-808-6165
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 000753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0546259Medicaid
PA01496301OtherBLUE CROSS IND
PA02499800OtherBLUE CROSS GRP
PA0546259Medicaid
PA0723530001Medicare NSC
PA02499800OtherBLUE CROSS GRP