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NPI Code Detail

MEDICARE: DR. MICHAEL L NOVAK O.D.

MEDICARE: DR. MICHAEL L NOVAK O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152WC0802XCorneal and Contact Management Optometrist2543MN

General Provider Information

NPI Number : 1265481212
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL L NOVAK O.D.
Provider Business Mailing Address
First Line : 1801 19TH AVE SW
Second Line :
City : WILLMAR
State : MN
Zip : 56201-4946
Country : US
Telephone Number : 320-235-2020
Fax Number : 320-214-5761
Provider Business Practice Location Address
First Line : 1801 19TH AVE SW
Second Line :
City : WILLMAR
State : MN
Zip : 56201-4946
Country : US
Telephone Number : 320-235-2020
Fax Number : 320-214-5761
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2006
Last Update Date : 01/16/2008

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