Provider Demographics
NPI:1407038656
Name:O'NEIL, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:O'NEIL
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 1:140 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1271
Mailing Address - Country:US
Mailing Address - Phone:978-448-5172
Mailing Address - Fax:978-448-6353
Practice Address - Street 1:140 MAIN ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1271
Practice Address - Country:US
Practice Address - Phone:978-448-5172
Practice Address - Fax:978-448-6353
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U87631Medicare UPIN
MAW17398Medicare PIN
0542780001Medicare NSC