Provider Demographics
NPI:1992854939
Name:O'BRIEN, MICHAEL DONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DONALD
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39 ELLIOTT DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2905
Mailing Address - Country:US
Mailing Address - Phone:413-458-5222
Mailing Address - Fax:413-443-0017
Practice Address - Street 1:OLD STATE ROAD
Practice Address - Street 2:PEARLE VISION, BERKSHIRE MALL
Practice Address - City:LANESBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01237
Practice Address - Country:US
Practice Address - Phone:413-448-2740
Practice Address - Fax:413-443-0017
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAW15690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOB158258Medicare ID - Type Unspecified