Provider Demographics
NPI:1821096173
Name:FEESER, MICHAEL EVAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EVAN
Last Name:FEESER
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 1:28 COX RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-9278
Mailing Address - Country:US
Mailing Address - Phone:410-414-9456
Mailing Address - Fax:
Practice Address - Street 1:4101 E 42ND ST
Practice Address - Street 2:STE 106
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-7245
Practice Address - Country:US
Practice Address - Phone:432-362-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1678152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist