Provider Demographics
NPI:1508980178
Name:WARE, MICHAEL DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:WARE
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 1:402 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3109
Mailing Address - Country:US
Mailing Address - Phone:662-539-7771
Mailing Address - Fax:662-539-7256
Practice Address - Street 1:402 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3109
Practice Address - Country:US
Practice Address - Phone:662-539-7771
Practice Address - Fax:662-539-7256
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880107Medicaid
MS410000274Medicare ID - Type Unspecified
MSU70745Medicare UPIN