Provider Demographics
NPI:1518935519
Name:ASHMAN, MICHAEL CAMERON (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CAMERON
Last Name:ASHMAN
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 1:3909 N VIENNA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-1780
Mailing Address - Country:US
Mailing Address - Phone:765-288-6197
Mailing Address - Fax:
Practice Address - Street 1:1501 E 29TH ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-5548
Practice Address - Country:US
Practice Address - Phone:765-284-4713
Practice Address - Fax:765-284-4791
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002869 A & B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN467160BMedicare ID - Type Unspecified
INU70393Medicare UPIN