Provider Demographics
NPI:1194998591
Name:TATUM, MICHAEL JAMES (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:TATUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:TATUM
Other - Middle Name:OPTICAL
Other - Last Name:SHOPPELLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7100 SIX FORKS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6156
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-676-2231
Practice Address - Street 1:2351 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4699
Practice Address - Country:US
Practice Address - Phone:919-282-0053
Practice Address - Fax:919-282-0057
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1277156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician