Provider Demographics
NPI:1205864402
Name:RAIM, MICHAEL E (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:RAIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:EDWARD
Other - Last Name:RAIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:501 HARBOR BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2348
Mailing Address - Country:US
Mailing Address - Phone:850-837-9161
Mailing Address - Fax:850-837-9162
Practice Address - Street 1:501 HARBOR BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2348
Practice Address - Country:US
Practice Address - Phone:850-837-9161
Practice Address - Fax:850-837-9162
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0001111152WC0802X, 152WX0102X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1245500677OtherORGANIZATION NPI
FL1245500677OtherORGANIZATION NPI