Provider Demographics
NPI:1285813162
Name:CAISTER, MICHAEL M (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:CAISTER
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 1:1921 FRED MOORE HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-4702
Mailing Address - Country:US
Mailing Address - Phone:810-326-3937
Mailing Address - Fax:810-326-0584
Practice Address - Street 1:1921 FRED MOORE HWY
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-4702
Practice Address - Country:US
Practice Address - Phone:810-326-3937
Practice Address - Fax:810-326-0584
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4408001Medicare PIN
MIU21468Medicare UPIN