Provider Demographics
NPI:1891863551
Name:SORENSEN, MICHAEL PHILIP (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PHILIP
Last Name:SORENSEN
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 1:2818 WHISPERING FERN CT
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-2227
Mailing Address - Country:US
Mailing Address - Phone:832-671-1265
Mailing Address - Fax:888-818-2152
Practice Address - Street 1:2818 WHISPERING FERN CT
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-2227
Practice Address - Country:US
Practice Address - Phone:832-671-1265
Practice Address - Fax:888-818-2152
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6106TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1804833SFX01Medicaid
TX180483303Medicaid
TX180483302Medicaid
TXP01089558Medicare PIN
TXTXB144328Medicare PIN
TX1804833SFX01Medicaid