Healthcare Provider Details

I. General information

NPI: 1083824361
Provider Name (Legal Business Name): MICHELLE M HEBERT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7775 N WICKHAM RD
MELBOURNE FL
32940-7914
US

IV. Provider business mailing address

995 N HIGHWAY A1A
INDIALANTIC FL
32903-2940
US

V. Phone/Fax

Practice location:
  • Phone: 321-984-3200
  • Fax:
Mailing address:
  • Phone: 321-961-3503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3701
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC3701
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: