Provider Demographics
NPI:1548544521
Name:STPETER, MICHAEL JOSEPH (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:STPETER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 HUGHES RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2220
Mailing Address - Country:US
Mailing Address - Phone:256-461-7100
Mailing Address - Fax:256-461-7101
Practice Address - Street 1:66 HUGHES RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2220
Practice Address - Country:US
Practice Address - Phone:256-461-7100
Practice Address - Fax:256-461-7101
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSC51TA902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100394118OtherGROUP NPI