Provider Demographics
NPI:1235312943
Name:MICHAEL SHURLEY O.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL SHURLEY O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-451-2378
Mailing Address - Street 1:426 W COLER ST
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-1441
Mailing Address - Country:US
Mailing Address - Phone:417-451-2378
Mailing Address - Fax:417-451-4484
Practice Address - Street 1:426 W COLER ST
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1441
Practice Address - Country:US
Practice Address - Phone:417-451-2378
Practice Address - Fax:417-451-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02772261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312558703Medicaid
000014123Medicare PIN
MO5691940001Medicare NSC
MO312558703Medicaid