Provider Demographics
NPI:1710976022
Name:GOERING, MICHAEL C (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:GOERING
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 1:5950 SW 28TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2540
Mailing Address - Country:US
Mailing Address - Phone:785-272-5904
Mailing Address - Fax:785-272-0136
Practice Address - Street 1:5950 SW 28TH ST STE B
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2540
Practice Address - Country:US
Practice Address - Phone:785-272-5904
Practice Address - Fax:785-272-0136
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1183-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS410044352OtherRR MEDICARE
KS100217930AMedicaid
KST43650Medicare UPIN
KS0462180001Medicare NSC
KS100217930AMedicaid