Provider Demographics
NPI:1972571289
Name:KIIHNL, MICHAEL DEWITT (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEWITT
Last Name:KIIHNL
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 1:707 MARION ST
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4833
Mailing Address - Country:US
Mailing Address - Phone:501-268-1818
Mailing Address - Fax:501-268-1894
Practice Address - Street 1:707 MARION ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4833
Practice Address - Country:US
Practice Address - Phone:501-268-1818
Practice Address - Fax:501-268-1894
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2295152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106539722Medicaid
AR49119G545Medicare PIN