Provider Demographics
NPI:1417166737
Name:MICHAEL W. GEIGER, OD PC
Entity Type:Organization
Organization Name:MICHAEL W. GEIGER, OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-482-1756
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-0899
Mailing Address - Country:US
Mailing Address - Phone:580-482-1756
Mailing Address - Fax:580-482-4279
Practice Address - Street 1:809 E TAMARACK RD
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521
Practice Address - Country:US
Practice Address - Phone:580-482-1756
Practice Address - Fax:580-482-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746780AMedicaid
OKOKB5280OtherPTAN
OK=========OtherTAX ID
OKDO4810Medicare PIN
OK100746780AMedicaid
OK442684033PMedicare PIN
OKU04486Medicare UPIN
OK1208610001Medicare NSC
OKD04810Medicare PIN
OKD04810OtherRAILROAD MEDICARE PTAN