Provider Demographics
NPI:1659776706
Name:MICHAEL J. NIEDERKORN, O.D., P.A.
Entity type:Organization
Organization Name:MICHAEL J. NIEDERKORN, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NIEDERKORN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-423-4435
Mailing Address - Street 1:190 E STACY RD STE 204
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1121
Mailing Address - Country:US
Mailing Address - Phone:972-678-4574
Mailing Address - Fax:972-678-1605
Practice Address - Street 1:190 E STACY RD STE 204
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-1121
Practice Address - Country:US
Practice Address - Phone:972-678-4574
Practice Address - Fax:972-678-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5266TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty