Individual provider Active NPI

Michael Wayne Cole, O.D.

  • Optometrist
  • Logan, UT
National Provider Identifier
1689970667
Registry record updated Sep 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9413616-8908 Issued in UT
Practice address
981 S Main St Ste 220
Logan, UT 84321-6055
Phone
(435) 363-2980
Fax
(435) 514-0075
NPI assigned
Feb 8, 2011
Last updated
Sep 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9413616-8908 UT Primary

Addresses

Primary practice location

981 S Main St Ste 220
Logan, UT 84321-6055

Mailing address

981 S Main St Ste 220
Logan, UT 84321-6055
Phone (435) 363-2980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150819009491 UT Practitioner - Optometry 9436464401 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

981 S Main St
Suite 220
Logan, UT 84321-6055
Phone (435) 363-2980

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9413616-8908UTMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Eye Care Center CurrentSince Jul 1, 2015 Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients

Locations

981 S Main St
Ste 220
Logan, UT 84321
Phone (435) 363-2980

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1689970667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "981 S MAIN ST STE 220",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843216055",
            "telephone_number": "435-363-2980",
            "fax_number": "435-514-0075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "981 S MAIN ST STE 220",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843216055",
            "telephone_number": "435-363-2980",
            "fax_number": "435-514-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLE",
        "first_name": "MICHAEL",
        "middle_name": "WAYNE",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-02-08",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "9413616-8908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, UT

Sources for this page

Verify at the official NPI Registry.