Provider Demographics
NPI:1336110212
Name:HARKINS, MICHAEL KELLY (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KELLY
Last Name:HARKINS
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:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707
Mailing Address - Country:US
Mailing Address - Phone:989-354-5890
Mailing Address - Fax:989-356-6213
Practice Address - Street 1:224 E CHISHOLM ST STE A
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2820
Practice Address - Country:US
Practice Address - Phone:989-354-5890
Practice Address - Fax:989-356-6213
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI000245152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900Z465080OtherBLUE CROSS
MIT33895Medicare UPIN
MI900Z465080OtherBLUE CROSS
MIZ44509001Medicare PIN