Mcgovern, Michael James

Mcgovern, Michael James is an individual health care provider with primary practice located at 624 Hawkins Ave Suite #1, Lake Ronkonkoma NY 11779-2324. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Mcgovern, Michael James can be contacted via phone (631) 588-5100.

Contact Information

Primary practice address
624 Hawkins Ave Suite #1 Lake Ronkonkoma NY 11779-2324
Phone: (631) 588-5100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X TUV5891 New York
Eye and Vision Services Providers / Optometrist 152W00000X OD2344 Tennessee

Profile Details

NPI number 1669470530
LBN Legal business name Mcgovern, Michael James
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 13th, 2005
Last updated May 13th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669470530 NPPES
New York MEDICAID 01870373

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