Provider Demographics
NPI:1407019904
Name:HOWLETTE, E MICHAEL
Entity Type:Individual
Prefix:
First Name:E
Middle Name:MICHAEL
Last Name:HOWLETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395A SPOTSYLVANIA TOWNE CENTRE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1124
Mailing Address - Country:US
Mailing Address - Phone:540-786-2020
Mailing Address - Fax:540-786-0609
Practice Address - Street 1:395A SPOTSYLVANIA TOWNE CENTRE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-1124
Practice Address - Country:US
Practice Address - Phone:540-786-2020
Practice Address - Fax:540-786-0609
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000172152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA332902OtherALLIANCE, MDIPA, UHC, MAMSI, OPTIMUM CHOICE
VAVA0727OtherEYEMED
VA263312OtherANTHEM
VA9203605Medicaid
VAU37801Medicare UPIN