Provider Demographics
NPI:1528062908
Name:RAY, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-1705
Mailing Address - Country:US
Mailing Address - Phone:317-346-4107
Mailing Address - Fax:317-346-4108
Practice Address - Street 1:110 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1705
Practice Address - Country:US
Practice Address - Phone:317-346-4107
Practice Address - Fax:317-346-4108
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002113A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200059300AMedicaid
IN5455650001Medicare NSC
IN200059300AMedicaid
IN6317200001Medicare NSC
IN1942432422Medicare NSC
INU32493Medicare UPIN