Provider Demographics
NPI:1659618684
Name:MICHAEL SIROTT, OD, PLLC
Entity Type:Organization
Organization Name:MICHAEL SIROTT, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIROTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-868-8604
Mailing Address - Street 1:PO BOX 10772
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99209-0772
Mailing Address - Country:US
Mailing Address - Phone:509-868-8604
Mailing Address - Fax:509-826-2556
Practice Address - Street 1:902 ENGH RD
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9473
Practice Address - Country:US
Practice Address - Phone:509-868-8604
Practice Address - Fax:509-826-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1508979493Medicaid