Provider Demographics
NPI:1386770626
Name:KERBY, MICHAEL DEAN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:KERBY
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 263
Mailing Address - Street 2:1001 MONROE ROAD
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-0263
Mailing Address - Country:US
Mailing Address - Phone:513-934-2020
Mailing Address - Fax:513-934-2028
Practice Address - Street 1:1001 MONROE RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1414
Practice Address - Country:US
Practice Address - Phone:513-934-2020
Practice Address - Fax:513-934-2028
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4756152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020870OtherANTHEM
OH6574OtherHUMANA
OH2053414Medicaid
OH281777OtherPREFERRED EYE CARE PROVID
OH0005188584OtherAETNA
OH2053414Medicaid
OH281777OtherPREFERRED EYE CARE PROVID