Provider Demographics
NPI:1619975588
Name:ESTES, MICHAEL K (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:ESTES
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 1:904 PACIFIC BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3149
Mailing Address - Country:US
Mailing Address - Phone:541-928-2020
Mailing Address - Fax:541-928-2043
Practice Address - Street 1:904 PACIFIC BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3149
Practice Address - Country:US
Practice Address - Phone:541-928-2020
Practice Address - Fax:541-928-2043
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR1225152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1619975588Medicaid
ORR152074Medicare PIN
OR1619975588Medicaid