Provider Demographics
NPI:1467521823
Name:MICHAUD, JAMES ALPHONSE (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALPHONSE
Last Name:MICHAUD
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 1:157 W HILL RD
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-1955
Mailing Address - Country:US
Mailing Address - Phone:207-582-4418
Mailing Address - Fax:
Practice Address - Street 1:157 W HILL RD
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-1955
Practice Address - Country:US
Practice Address - Phone:207-582-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist