Provider Demographics
NPI:1710975917
Name:KWARCINSKI, MICHAEL M (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:KWARCINSKI
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 1:5510 HIGHWAY 280
Mailing Address - Street 2:SUITE 213
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6582
Mailing Address - Country:US
Mailing Address - Phone:205-981-0103
Mailing Address - Fax:205-981-6428
Practice Address - Street 1:5510 HIGHWAY 280
Practice Address - Street 2:SUITE 213
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6582
Practice Address - Country:US
Practice Address - Phone:205-981-0103
Practice Address - Fax:205-981-6428
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS888TA444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000020895Medicaid
AL000020894Medicaid
AL20895Medicare ID - Type Unspecified
AL1074080015Medicare NSC
AL1074080001Medicare NSC
AK000020895Medicare PIN
AL000020894Medicare PIN
U76754Medicare UPIN
AL20894Medicare ID - Type Unspecified