Provider Demographics
NPI:1417951179
Name:CONTE, MICHAEL D (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:CONTE
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 1:6636 LAKE WORTH BLVD
Mailing Address - Street 2:SIUTE 300
Mailing Address - City:LAKE WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-3026
Mailing Address - Country:US
Mailing Address - Phone:817-626-4441
Mailing Address - Fax:
Practice Address - Street 1:6636 LAKE WORTH BLVD
Practice Address - Street 2:SIUTE 300
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3026
Practice Address - Country:US
Practice Address - Phone:817-626-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03120T152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1851580351OtherMEDICARE UNSPECIFIED
TX81282QOtherBLUECROSS BLUESHIELD
TX410049704Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX00648UMedicare PIN
TX5125280003Medicare NSC
TX8A3015Medicare UPIN
TXT12758Medicare PIN
TX81282QOtherBLUECROSS BLUESHIELD