Provider Demographics
NPI:1376581223
Name:MICHELS, M MORSE (OD)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:MORSE
Last Name:MICHELS
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 1:2218 STATE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1501
Mailing Address - Country:US
Mailing Address - Phone:610-626-4355
Mailing Address - Fax:610-626-5182
Practice Address - Street 1:2218 STATE RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1501
Practice Address - Country:US
Practice Address - Phone:610-626-4355
Practice Address - Fax:610-626-5182
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAOEG000033152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0033149000OtherHMO
PA000285878OtherBLUE SHIELD
PA11255Medicare UPIN
PA000285878OtherBLUE SHIELD