Provider Demographics
NPI:1366450108
Name:O'NEAL, MICHAEL LEONARD (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEONARD
Last Name:O'NEAL
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 1:1089 E MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1744
Mailing Address - Country:US
Mailing Address - Phone:765-342-2050
Mailing Address - Fax:765-342-2050
Practice Address - Street 1:1089 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1744
Practice Address - Country:US
Practice Address - Phone:765-342-2050
Practice Address - Fax:765-342-2050
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100186570Medicaid
IL563910Medicare ID - Type Unspecified