Provider Demographics
NPI:1417051616
Name:WOLF, MICHAEL ALAN (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:WOLF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13179 GARRETT HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550
Mailing Address - Country:US
Mailing Address - Phone:301-334-8200
Mailing Address - Fax:301-334-8200
Practice Address - Street 1:13179 GARRETT HWY
Practice Address - Street 2:SUITE C
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:301-334-8200
Practice Address - Fax:301-334-8200
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDA804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
918922OtherBLOCK VISION
42289401OtherBCBS OF MD
918922OtherBLOCK VISION
42289401OtherBCBS OF MD