Provider Demographics
NPI:1639149222
Name:O'REILLY, MICHAEL JULES (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JULES
Last Name:O'REILLY
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:PO BOX 13416
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44334-8816
Mailing Address - Country:US
Mailing Address - Phone:330-645-9780
Mailing Address - Fax:330-645-1302
Practice Address - Street 1:2887 S ARLINGTON RD
Practice Address - Street 2:VISION CENTER
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4715
Practice Address - Country:US
Practice Address - Phone:330-645-9560
Practice Address - Fax:330-645-1302
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3192152WC0802X, 152W00000X
CA6311152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0548063Medicaid
OH4111516Medicare PIN
OH0548063Medicaid