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General NPI Number Information
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NPI Number | 1528087681
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Entity Type | Individual
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Provider Name | MICHAEL JOHN NIEDERKORN O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 190 E STACY RD STE 204
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City | ALLEN
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State | TX
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Zip | 75002-1121
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Country | US
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Telephone | 972-678-4574
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Fax | 972-678-1605
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Provider Business Mailing Address
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Address Line | 9862 ATLANTIC LN
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City | FRISCO
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State | TX
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Zip | 75035-5035
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Country | US
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Telephone | 972-381-0729
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5266TG
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License Number State | TX
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