Provider Demographics
NPI:1649280405
Name:BUZBEE, MICHAEL A (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:BUZBEE
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 1:2102 N GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1603
Mailing Address - Country:US
Mailing Address - Phone:432-367-5600
Mailing Address - Fax:432-368-9817
Practice Address - Street 1:2102 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1603
Practice Address - Country:US
Practice Address - Phone:432-367-5600
Practice Address - Fax:432-368-9817
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03017TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0593520001OtherDMERC
TX0593520001OtherDMERC
TXT90570Medicare UPIN
TX00E69CMedicare PIN