Provider Demographics
NPI:1275541302
Name:SPRAY, MICHELLE D (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:D
Last Name:SPRAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E SCHOOL ST
Mailing Address - Street 2:P.O. BOX 446
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1722
Mailing Address - Country:US
Mailing Address - Phone:573-358-4148
Mailing Address - Fax:573-358-4149
Practice Address - Street 1:70 E SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1722
Practice Address - Country:US
Practice Address - Phone:573-358-4148
Practice Address - Fax:573-358-4149
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3239152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU66878Medicare UPIN
MO5648700001Medicare NSC