Provider Demographics
NPI:1215988027
Name:OMEARA, MICHAEL J (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:OMEARA
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 1:225 W ASHLAND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-2462
Mailing Address - Country:US
Mailing Address - Phone:515-961-5305
Mailing Address - Fax:515-961-9225
Practice Address - Street 1:225 W ASHLAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-2462
Practice Address - Country:US
Practice Address - Phone:515-961-5305
Practice Address - Fax:515-961-9225
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1069542Medicaid
IA0069542Medicaid
U00951Medicare UPIN
IA0069542Medicaid
IA00282Medicare PIN