Provider Demographics
NPI:1710289376
Name:MICHAEL T POYNOR OD PA
Entity Type:Organization
Organization Name:MICHAEL T POYNOR OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:POYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-937-6869
Mailing Address - Street 1:807 W MARVIN AVE
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-3023
Mailing Address - Country:US
Mailing Address - Phone:972-937-6869
Mailing Address - Fax:
Practice Address - Street 1:110 N ADELAIDE ST
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2709
Practice Address - Country:US
Practice Address - Phone:972-563-3253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2294T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB121068Medicare PIN
TX00E26HMedicare PIN
TXTXB120667Medicare PIN