Provider Demographics
NPI:1629327002
Name:AU, MICHAEL J (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:AU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2018
Mailing Address - Country:US
Mailing Address - Phone:954-262-4200
Mailing Address - Fax:954-262-2269
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:ZIFF BUILDING 2ND FLOOR
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-4200
Practice Address - Fax:954-262-3904
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006548100Medicaid