Provider Demographics
NPI:1225228752
Name:MICHELINE D TAYLOR
Entity Type:Organization
Organization Name:MICHELINE D TAYLOR
Other - Org Name:COVE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:254-547-2683
Mailing Address - Street 1:302 E HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2939
Mailing Address - Country:US
Mailing Address - Phone:254-547-2683
Mailing Address - Fax:254-547-4099
Practice Address - Street 1:304 E HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2939
Practice Address - Country:US
Practice Address - Phone:254-547-2020
Practice Address - Fax:254-542-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3854TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00158SMedicare PIN