Healthcare Provider Details

I. General information

NPI: 1912990425
Provider Name (Legal Business Name): MICHELLE M NAVE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MARTIN DRIVE
FREDONIA WI
53021-2408
US

IV. Provider business mailing address

14643 MERCANTILE DR N STE 112
HUGO MN
55038-4632
US

V. Phone/Fax

Practice location:
  • Phone: 262-692-9000
  • Fax:
Mailing address:
  • Phone: 651-426-3630
  • Fax: 651-426-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2750
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: