Provider Demographics
NPI:1518027531
Name:HERR, MICHAEL J (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:HERR
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 1:122 SOUTH COUNTY CENTERWAY
Mailing Address - Street 2:STE A TENHOLDER PLAZA
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129
Mailing Address - Country:US
Mailing Address - Phone:314-487-8555
Mailing Address - Fax:314-487-8518
Practice Address - Street 1:122 SOUTH COUNTY CENTERWAY
Practice Address - Street 2:STE A TENHOLDER PLAZA
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129
Practice Address - Country:US
Practice Address - Phone:314-487-8555
Practice Address - Fax:314-487-8518
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILT02251152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1595016Medicare PIN
IL156617Medicare UPIN