Provider Demographics
NPI:1922151133
Name:JAMES, MICHAEL RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:JAMES
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 1:3900 E MEXICO AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3941
Mailing Address - Country:US
Mailing Address - Phone:817-784-0222
Mailing Address - Fax:817-417-0981
Practice Address - Street 1:505 N GUN BARREL LN
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-3732
Practice Address - Country:US
Practice Address - Phone:817-784-0222
Practice Address - Fax:817-417-0981
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3054TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020199803Medicaid
TX020199802Medicaid
TX020199803Medicaid
TX8L26349Medicare PIN
TX8J3576Medicare PIN