Healthcare Provider Details

I. General information

NPI: 1720135015
Provider Name (Legal Business Name): MICHAEL AARON WHEELER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 HIGHWAY 5 N
MOUNTAIN HOME AR
72653-3039
US

IV. Provider business mailing address

102 SPRING ST
MELBOURNE AR
72556-9241
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-2277
  • Fax: 870-425-2021
Mailing address:
  • Phone: 870-368-7921
  • Fax: 870-368-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number2558
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number2005020771
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: