Provider Demographics
NPI:1881687515
Name:SERRANO, MICHAEL L (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:SERRANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5462 MEMORIAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3239
Mailing Address - Country:US
Mailing Address - Phone:404-296-6000
Mailing Address - Fax:404-296-3600
Practice Address - Street 1:5462 MEMORIAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3239
Practice Address - Country:US
Practice Address - Phone:404-296-6000
Practice Address - Fax:404-296-3600
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1770152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA189691321AMedicaid
GAGRP7184Medicare Oscar/Certification
GA41ZCFVPMedicare PIN
GAU81546Medicare UPIN