MEDICARE: MICHAEL PHILIP CEREAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9202T	TX

General Provider Information

NPI Number	:	1023534922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PHILIP CEREAN OD

Provider Business Mailing Address
First Line	:	24307 HAELI PARK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-2281
Country	:	US
Telephone Number	:	832-527-4179
Fax Number	:

Provider Business Practice Location Address
First Line	:	3331 WURZBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-4042
Country	:	US
Telephone Number	:	210-647-3333
Fax Number	:	210-680-5965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	03/17/2018

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