Provider Demographics
NPI:1871591800
Name:GEIGER, MICHAEL W (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:GEIGER
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 899
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-0899
Mailing Address - Country:US
Mailing Address - Phone:580-482-1756
Mailing Address - Fax:580-482-4279
Practice Address - Street 1:809 E TAMARACK RD
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1231
Practice Address - Country:US
Practice Address - Phone:580-482-1756
Practice Address - Fax:580-482-4279
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762720BMedicaid
OK731530230OtherTAX ID
OKP00684860Medicare PIN
OK100762720BMedicaid
OK1208610001Medicare NSC
OK$$$$$$$$$PMedicare PIN
OKP00684860OtherRETIRED RAILROAD MEDICARE