Provider Demographics
NPI:1821007915
Name:TATE, MICHAEL HOBART (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HOBART
Last Name:TATE
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 1:3625 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2813
Mailing Address - Country:US
Mailing Address - Phone:405-943-9548
Mailing Address - Fax:405-943-4834
Practice Address - Street 1:3625 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2813
Practice Address - Country:US
Practice Address - Phone:405-943-9548
Practice Address - Fax:405-943-4834
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK249512902Medicare PIN
OKT40680Medicare UPIN