Provider Demographics
NPI:1659420479
Name:MCNAMARA, MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCNAMARA
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 1:730 HIDDEN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-2525
Mailing Address - Country:US
Mailing Address - Phone:248-446-1529
Mailing Address - Fax:
Practice Address - Street 1:4600 BALDWIN RD
Practice Address - Street 2:GREAT LAKES CROSSING OAKLAND POINTE SP 333
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1281
Practice Address - Country:US
Practice Address - Phone:248-333-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU84689Medicare UPIN
MIN26930005Medicare ID - Type Unspecified