Provider Demographics
NPI:1992018600
Name:ATTEBERRY, MICHAEL JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:ATTEBERRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5100 BOB BILLINGS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4094
Mailing Address - Country:US
Mailing Address - Phone:785-841-2020
Mailing Address - Fax:785-841-0420
Practice Address - Street 1:3201 S IOWA
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046
Practice Address - Country:US
Practice Address - Phone:785-841-2020
Practice Address - Fax:785-841-0420
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1860152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist