Provider Demographics
NPI:1932647054
Name:O'NEAL, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22847 EAST 16
Mailing Address - Street 2:
Mailing Address - City:HORNICK
Mailing Address - State:IA
Mailing Address - Zip Code:51026
Mailing Address - Country:US
Mailing Address - Phone:712-420-3068
Mailing Address - Fax:
Practice Address - Street 1:305 DAKOTA DUNES BLVD
Practice Address - Street 2:
Practice Address - City:NORTH SIOUX CITY
Practice Address - State:SD
Practice Address - Zip Code:57049-5176
Practice Address - Country:US
Practice Address - Phone:712-420-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SD736152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program