Provider Demographics
NPI:1275570251
Name:STUTTS, MICHAEL OWEN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:OWEN
Last Name:STUTTS
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 1:605 RIVER BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-2506
Mailing Address - Country:US
Mailing Address - Phone:256-381-8970
Mailing Address - Fax:
Practice Address - Street 1:401 COX BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-4058
Practice Address - Country:US
Practice Address - Phone:256-314-4424
Practice Address - Fax:256-314-4535
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS654TA084152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510322273OtherBCBS OF AL
AL000032273Medicaid
AL000032273Medicaid