Healthcare Provider Details

I. General information

NPI: 1164457750
Provider Name (Legal Business Name): MICHAEL ANTHONY MORRISON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 SOUTH HIGHWAY 59
MAHNOMEN MN
56557-5007
US

IV. Provider business mailing address

785 SOUTH HIGHWAY 59 PO BOX 339
MAHNOMEN MN
56557-5007
US

V. Phone/Fax

Practice location:
  • Phone: 218-936-2020
  • Fax: 218-935-5541
Mailing address:
  • Phone: 218-936-2020
  • Fax: 218-935-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2977
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: