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NPI Code Detail

MEDICARE: DR. MICHELENE TODD O.D.

MEDICARE: DR. MICHELENE TODD O.D.
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
1152W00000XOptometrist002362CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962400416
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHELENE TODD O.D.
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 : 775 MAIN ST S
Second Line :
City : SOUTHBURY
State : CT
Zip : 06488-2271
Country : US
Telephone Number : 203-262-6752
Fax Number : 203-262-6701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 03/26/2022

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