Healthcare Provider Details

I. General information

NPI: 1073572806
Provider Name (Legal Business Name): MICHAEL LOCKHART JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 LINCOLN WAY E
MASSILLON OH
44646-6833
US

IV. Provider business mailing address

1151 MELSCHEIMER RD SW
EAST SPARTA OH
44626-9752
US

V. Phone/Fax

Practice location:
  • Phone: 330-833-1091
  • Fax: 330-833-1092
Mailing address:
  • Phone: 330-484-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: