Provider Demographics
NPI:1164419354
Name:BILLINGS, MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BILLINGS
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 1:1200 W DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-997-6250
Practice Address - Street 1:2511 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2338
Practice Address - Country:US
Practice Address - Phone:573-686-5866
Practice Address - Fax:573-686-0425
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO33792830Medicaid
IL2731OtherEYEMED
MO0814870017OtherMEDICARE NSC NUMBER
081066OtherHEALTH ALLIANCE
MO0814870013OtherMEDICARE NSC NUMBER
MO147084OtherANTHEM BLUE CROSS BLUE SHIELD OF MO
MO410049553, CI6574OtherMEDICARE RAILROAD
MO410049553, CI6574OtherMEDICARE RAILROAD
IL2731OtherEYEMED
MO33792830Medicaid