Healthcare Provider Details

I. General information

NPI: 1043251887
Provider Name (Legal Business Name): MICHAEL S. ZIRKLE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W 38TH ST
MARION IN
46953-4864
US

IV. Provider business mailing address

610 W 38TH ST
MARION IN
46953-4864
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-7525
  • Fax: 765-674-7844
Mailing address:
  • Phone: 765-674-7525
  • Fax: 765-674-7844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002526
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: