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General NPI Number Information
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NPI Number | 1659776706
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Entity Type | Organization
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Legal Business Name | MICHAEL J. NIEDERKORN, O.D., P.A.
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Dates
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Enumeration Date | 10/31/2014
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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 | 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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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL JOHN NIEDERKORN
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Credential | O.D.
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Telephone | 972-423-4435
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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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