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General NPI Number Information
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NPI Number | 1811092125
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Entity Type | Individual
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Provider Name | MICHAEL L MORGENTHALER O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 615 STATE STREET
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City | MADISON
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State | WI
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Zip | 53703
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Country | US
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Telephone | 608-251-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 2746 CHAMBERLAIN AVE
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City | MADISON
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State | WI
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Zip | 53705-3720
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Country | US
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Telephone | 608-231-2822
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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 | 1824
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License Number State | WI
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