Healthcare Provider Details

I. General information

NPI: 1518172287
Provider Name (Legal Business Name): MICHELE STANLEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE RASHID-STANLEY O.D.

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NITRO MARKET PL
CROSS LANES WV
25313-4401
US

IV. Provider business mailing address

1542 THOMAS CIR
CHARLESTON WV
25314-1623
US

V. Phone/Fax

Practice location:
  • Phone: 304-769-2253
  • Fax: 304-769-2254
Mailing address:
  • Phone: 304-344-0162
  • Fax: 304-769-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberWV851OD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: