Provider Demographics
NPI:1023116258
Name:NORRIS, MICHAEL O (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:O
Last Name:NORRIS
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:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-1132
Mailing Address - Country:US
Mailing Address - Phone:870-238-7973
Mailing Address - Fax:870-238-7974
Practice Address - Street 1:619 CANAL AVE E
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3003
Practice Address - Country:US
Practice Address - Phone:870-238-7973
Practice Address - Fax:870-238-7974
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20260Medicare UPIN
AR48984Medicare PIN