MEDICARE: DR. MICHELLE L ESSEX 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
1	152W00000X	Optometrist	2325	CO

General Provider Information

NPI Number	:	1528060795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE L ESSEX O.D.

Provider Business Mailing Address
First Line	:	12075 E 45TH AVE
Second Line	:	STE 210
City	:	DENVER
State	:	CO
Zip	:	80239-3122
Country	:	US
Telephone Number	:	303-371-2020
Fax Number	:	303-371-8022

Provider Business Practice Location Address
First Line	:	12075 E 45TH AVE
Second Line	:	STE 210
City	:	DENVER
State	:	CO
Zip	:	80239-3122
Country	:	US
Telephone Number	:	303-371-2020
Fax Number	:	303-371-8022

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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