Provider Demographics
NPI:1477577369
Name:WERTELET, MICHELLE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:WERTELET
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1005 BEAVER GRADE RD STE G10
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2964
Mailing Address - Country:US
Mailing Address - Phone:412-308-9111
Mailing Address - Fax:412-308-9112
Practice Address - Street 1:1005 BEAVER GRADE RD STE G10
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2964
Practice Address - Country:US
Practice Address - Phone:412-308-9111
Practice Address - Fax:412-308-9112
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020734660001Medicaid
PAV06506Medicare UPIN