Provider Demographics
NPI:1164457750
Name:MORRISON, MICHAEL ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:MORRISON
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 1:785 SOUTH HIGHWAY 59
Mailing Address - Street 2:PO BOX 339
Mailing Address - City:MAHNOMEN
Mailing Address - State:MN
Mailing Address - Zip Code:56557-5007
Mailing Address - Country:US
Mailing Address - Phone:218-936-2020
Mailing Address - Fax:218-935-5541
Practice Address - Street 1:785 SOUTH HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:MAHNOMEN
Practice Address - State:MN
Practice Address - Zip Code:56557-5007
Practice Address - Country:US
Practice Address - Phone:218-936-2020
Practice Address - Fax:218-935-5541
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN316K0MOOtherBCBS
MN2202521OtherMEDICA
MN411895571102OtherUNICARE
MN316KOMOOtherNATIONAL TRIBAL CLAIMS CE
MN0559830003OtherDMERC
MN483361046248OtherPREFERRED ONE
MN051127011OtherMETROPOLITAN HEALTH PLAN
MN512428000Medicaid
MNV00984Medicare UPIN
MN483361046248OtherPREFERRED ONE