Provider Demographics
NPI:1124072871
Name:MORRIS, MICHAEL J (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MORRIS
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:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:HILLVIEW
Mailing Address - State:KY
Mailing Address - Zip Code:40129-0667
Mailing Address - Country:US
Mailing Address - Phone:502-968-2720
Mailing Address - Fax:029-682-7215
Practice Address - Street 1:11901 STANDIFORD PLAZA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-5906
Practice Address - Country:US
Practice Address - Phone:502-968-2720
Practice Address - Fax:502-968-2721
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1487DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000552Medicaid
KY77000552Medicaid
U81656Medicare UPIN
000000475423OtherANTHEM BCBS