Michael Dale Mortimer, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3906 Issued in NY

Practice address

130 S Union St
Ste. 8
Olean, NY 14760-9807

Phone

(716) 372-8644

Fax

(716) 373-4257

NPI assigned

Sep 19, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Allegany Associates LLC

  • Ambulatory Surgical Clinic/Center
  • Olean, NY
  • NPI 1528832607
  NPD (past)

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232496000000",
    "number": "1801881578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 S UNION ST",
            "address_2": "STE. 8",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147609807",
            "telephone_number": "716-372-8644",
            "fax_number": "716-373-4257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 S UNION ST",
            "address_2": "STE. 8",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147609807",
            "telephone_number": "716-372-8644",
            "fax_number": "716-373-4257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTIMER",
        "first_name": "MICHAEL",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-19",
        "last_updated": "2009-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "3906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "NY3906",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00606964",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dorota Maria Morawska, PT
• Mariusz Cezary Morawski, PT
• Wayne Morgan, OPTICIAN
• Lori Kay Morrill, PA
• Emily Grace Morris, COTA
• Neila Murphy, RN
• Tenisha Lynne Murphy, FNP
• Kara N Neal, DPT
• Kathleen Anne Neeson, RN
• Lynn Marie Neeson, PT, DPT

• Optometrist in Olean, NY
• Providers in Olean, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.