Provider Demographics
NPI:1326006784
Name:VALELLA, MICHELLE T (OD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:VALELLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:7055 TOWER RD STE E
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8604
Practice Address - Country:US
Practice Address - Phone:269-968-8183
Practice Address - Fax:269-968-1998
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410018510OtherRR MEDICARE
MI0A36555OtherBCBS
410018510OtherRR MEDICARE
MI0A36555OtherBCBS
T91136Medicare UPIN