Provider Demographics
NPI:1487663365
Name:POWERS, MICHAEL THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:POWERS
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 1:4060 WATERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1956
Mailing Address - Country:US
Mailing Address - Phone:513-720-3417
Mailing Address - Fax:
Practice Address - Street 1:2749 EDMONDSON RD
Practice Address - Street 2:LOCATED INSIDE LENSCRAFTERS
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1912
Practice Address - Country:US
Practice Address - Phone:513-631-5181
Practice Address - Fax:513-631-3517
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1175DT152W00000X
IN18002498152W00000X
OH4165/T097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH969700OtherMEDICARE
OH0001188Medicaid
OHPO0675377Medicare PIN