Provider Demographics
NPI:1720135015
Name:WHEELER, MICHAEL AARON (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:AARON
Last Name:WHEELER
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 1:102 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-9241
Mailing Address - Country:US
Mailing Address - Phone:870-368-7921
Mailing Address - Fax:870-368-7789
Practice Address - Street 1:360 HIGHWAY 5 N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3039
Practice Address - Country:US
Practice Address - Phone:870-425-2277
Practice Address - Fax:870-425-2021
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2558152WL0500X
MO2005020771152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159563722Medicaid
ARV06851Medicare UPIN
AR499297467Medicare PIN
AR159563722Medicaid