Provider Demographics
NPI:1669530259
Name:HOULE, MICHAEL G (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:HOULE
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 1:1929 N WASHINGTON ST STE AA
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1616
Mailing Address - Country:US
Mailing Address - Phone:701-255-7894
Mailing Address - Fax:701-989-6098
Practice Address - Street 1:1929 N WASHINGTON ST STE AA
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1616
Practice Address - Country:US
Practice Address - Phone:701-255-7894
Practice Address - Fax:701-989-6098
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND496152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND712628Medicare PIN