Provider Demographics
NPI:1174517726
Name:MICHAELS, JEFFREY CARTER (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CARTER
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 INNSLAKE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3344
Mailing Address - Country:US
Mailing Address - Phone:804-217-9883
Mailing Address - Fax:804-217-9065
Practice Address - Street 1:4114 INNSLAKE DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3344
Practice Address - Country:US
Practice Address - Phone:804-217-9883
Practice Address - Fax:804-217-9065
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601800085152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2634406OtherAETNA HMO
VA7360063OtherAETNA NON HMO
VA273089OtherMAMSI GENERAL OPTOMETRY
VA92-3481-1Medicaid
VA473089OtherMAMSI SPECIALIST NUMBER
VA182026OtherANTHEM REE
VA269403OtherANTHEM RH ROBINSON
VA2634406OtherAETNA HMO
VA410001114Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
VA269403OtherANTHEM RH ROBINSON
VA182026OtherANTHEM REE