Provider Demographics
NPI:1427196054
Name:THELEN, MICHELLE ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:THELEN
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 1:7630 LITTLE RIVER TPKE STE 100
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2614
Mailing Address - Country:US
Mailing Address - Phone:703-941-4111
Mailing Address - Fax:703-941-3929
Practice Address - Street 1:7630 LITTLE RIVER TPKE STE 100
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2614
Practice Address - Country:US
Practice Address - Phone:703-941-4111
Practice Address - Fax:703-941-3929
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist