Provider Demographics
NPI:1326047820
Name:ALVAREZ, MICHAEL MANUEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MANUEL
Last Name:ALVAREZ
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 1:403 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-1424
Mailing Address - Country:US
Mailing Address - Phone:260-415-0267
Mailing Address - Fax:260-969-0322
Practice Address - Street 1:403 WALKER ST
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-1424
Practice Address - Country:US
Practice Address - Phone:260-969-1400
Practice Address - Fax:260-673-5875
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN220440AMedicare ID - Type Unspecified
INU59734Medicare UPIN