Provider Demographics
NPI:1407060320
Name:CANTRELL, MICHELLE COOPER (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:COOPER
Last Name:CANTRELL
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 1:2830 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4331
Mailing Address - Country:US
Mailing Address - Phone:559-636-1000
Mailing Address - Fax:559-733-7438
Practice Address - Street 1:2830 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4331
Practice Address - Country:US
Practice Address - Phone:559-636-1000
Practice Address - Fax:559-733-7438
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10757 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist