MEDICARE: MICHELLE BIDDLE

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	156FX1800X	Optician	277033	KY

General Provider Information

NPI Number	:	1821728684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE BIDDLE

Provider Business Mailing Address
First Line	:	3450 VALLEY PLAZA PKWY
Second Line	:
City	:	FT WRIGHT
State	:	KY
Zip	:	41017-8177
Country	:	US
Telephone Number	:	859-341-3767
Fax Number	:	859-341-3789

Provider Business Practice Location Address
First Line	:	3450 VALLEY PLAZA PKWY
Second Line	:
City	:	FT WRIGHT
State	:	KY
Zip	:	41017-8177
Country	:	US
Telephone Number	:	859-341-3767
Fax Number	:	859-371-3789

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

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/14/2022

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Directions to “ MICHELLE BIDDLE ” Practice Location

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