MEDICARE: M. MORSE MICHELS PC

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
1	152W00000X	Optometrist	PAOEG000033	PA

General Provider Information

NPI Number	:	1558497677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. MORSE MICHELS PC

Provider Business Mailing Address
First Line	:	2218 STATE RD
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-1501
Country	:	US
Telephone Number	:	610-626-4355
Fax Number	:	610-626-5182

Provider Business Practice Location Address
First Line	:	2218 STATE RD
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-1501
Country	:	US
Telephone Number	:	610-626-4355
Fax Number	:	610-626-5182

Authorized Official
Title or Position	:	PRESIDENT
Name	:	M. MORSE MICHELS
Credential	:	O.D.
Telephone Number	:	610-664-0930

Provider Enumeration Date	:	02/25/2007
Last Update Date	:	06/02/2008

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