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NPI Code Detail

MEDICARE: MICHELLE ELIZABETH TAYLOR O.D.

MEDICARE: MICHELLE ELIZABETH TAYLOR 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
1152WV0400XVision Therapy Optometrist2605MN
2152W00000XOptometrist2605MN

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 : 1528090420
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE ELIZABETH TAYLOR O.D.
Provider Business Mailing Address
First Line : 4243 4TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55409-2113
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4243 4TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55409-2113
Country : US
Telephone Number : 612-821-2003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 10/14/2020

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