Provider Demographics
NPI:1174873574
Name:HEAD, MICHAEL KEITH (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KEITH
Last Name:HEAD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1872 NORWOOD DR
Mailing Address - Street 2:STE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3066
Mailing Address - Country:US
Mailing Address - Phone:817-540-6060
Mailing Address - Fax:817-553-7994
Practice Address - Street 1:1872 NORWOOD DR
Practice Address - Street 2:STE 200
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3066
Practice Address - Country:US
Practice Address - Phone:817-540-6060
Practice Address - Fax:817-553-7994
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8069TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist