Provider Demographics
NPI:1730210220
Name:BIDDLE, MICHAEL A (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:BIDDLE
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 1:461 OLDS ST
Mailing Address - Street 2:P.O. BOX 129
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-9433
Mailing Address - Country:US
Mailing Address - Phone:517-849-9277
Mailing Address - Fax:517-849-2134
Practice Address - Street 1:461 OLDS ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-9433
Practice Address - Country:US
Practice Address - Phone:517-849-9277
Practice Address - Fax:517-849-2134
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2844410Medicaid
MI35212OtherHEALTH PLAN OF MICHIGAN
MI900C010240OtherBCBS
MI2220036OtherPHP
MI580002619OtherRAILROAD MEDICARE
MI0563630001OtherDME MEDICARE
MI35212OtherHEALTH PLAN OF MICHIGAN
MIT32845Medicare UPIN