Provider Demographics
NPI:1851580351
Name:MICHAEL D. CONTE PC
Entity Type:Organization
Organization Name:MICHAEL D. CONTE PC
Other - Org Name:LAKE WORTH VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-626-4441
Mailing Address - Street 1:6636 LAKE WORTH BLVD
Mailing Address - Street 2:STE. 300
Mailing Address - City:LAKE WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-3026
Mailing Address - Country:US
Mailing Address - Phone:817-626-4441
Mailing Address - Fax:817-237-3438
Practice Address - Street 1:6636 LAKE WORTH BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3026
Practice Address - Country:US
Practice Address - Phone:817-626-4441
Practice Address - Fax:817-625-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3120T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A3015Medicare UPIN
TXT12758Medicare PIN
TX5125280002Medicare NSC
TX410006077Medicare PIN
TX00648UMedicare PIN
TX5125280003Medicare NSC