MEDICARE: MICHELLE T VALELLA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901003234	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410018510	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0A36555	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1326006784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE T VALELLA OD

Provider Business Mailing Address
First Line	:	1950 OLD GALLOWS RD STE 520
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-3970
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	571-223-6780

Provider Business Practice Location Address
First Line	:	7055 TOWER RD STE E
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-8604
Country	:	US
Telephone Number	:	269-968-8183
Fax Number	:	269-968-1998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	03/31/2021

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