Provider Demographics
NPI:1285695916
Name:WESSON, MICHAEL DAVID (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:WESSON
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 1:5001 TAYLOR ROAD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4722
Mailing Address - Country:US
Mailing Address - Phone:941-575-0903
Mailing Address - Fax:941-575-0905
Practice Address - Street 1:5001 TAYLOR ROAD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4722
Practice Address - Country:US
Practice Address - Phone:941-575-0903
Practice Address - Fax:941-575-0905
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR117-TA-093152W00000X
FLOPC0843152W00000X
GAOPT002219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20767AOtherMEDICARE ID - TYPE UNSPECIFIED
FL084066100Medicaid
FL20767OtherBLUE CROSS BLUE SHIELD
FL084066100Medicaid