Provider Demographics
NPI:1366637274
Name:MAXWELL, MICHELE CHASE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:CHASE
Last Name:MAXWELL
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 1:99 BATTERY PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1320
Mailing Address - Country:US
Mailing Address - Phone:212-945-6789
Mailing Address - Fax:
Practice Address - Street 1:453 E 14TH ST
Practice Address - Street 2:APT 12B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2822
Practice Address - Country:US
Practice Address - Phone:646-709-1967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100024240Medicare PIN