Provider Demographics
NPI:1265495220
Name:MORABITO, MICHAEL Z (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:Z
Last Name:MORABITO
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:88 FOLLY ROAD BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7551
Practice Address - Country:US
Practice Address - Phone:843-573-9944
Practice Address - Fax:843-573-9969
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1261152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC922OtherBLUE CHOICE HEALTH PLAN
SC1261OtherSTATE OPTOMETRY LICENSE NUMBER
SCU952847884OtherINSTILL HEALTH INSURANCE
SC200828972OtherBLUE CROSS BLUE SHEILD
SCE1473OtherMEDCOST
SCD12617Medicaid
SCD12617Medicaid