Provider Demographics
NPI:1972693992
Name:PRESLEY, MICHAEL L (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:PRESLEY
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 1:113 WINDSONG CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-8861
Mailing Address - Country:US
Mailing Address - Phone:662-213-5877
Mailing Address - Fax:662-534-5912
Practice Address - Street 1:2885 MCCULLOUGH BLVD.
Practice Address - Street 2:SUITE F
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-9022
Practice Address - Country:US
Practice Address - Phone:662-791-0454
Practice Address - Fax:662-791-0464
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSVO3545Medicare UPIN
MS410000328Medicare ID - Type Unspecified