Provider Demographics
NPI:1487017844
Name:STACEY MICHAELS OD PLLC
Entity Type:Organization
Organization Name:STACEY MICHAELS OD PLLC
Other - Org Name:ROKA OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:906-481-7652
Mailing Address - Street 1:37750 S ENTRY RD
Mailing Address - Street 2:
Mailing Address - City:CHASSELL
Mailing Address - State:MI
Mailing Address - Zip Code:49916-9258
Mailing Address - Country:US
Mailing Address - Phone:906-481-7652
Mailing Address - Fax:906-481-2020
Practice Address - Street 1:45070 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:CHASSELL
Practice Address - State:MI
Practice Address - Zip Code:49916-9116
Practice Address - Country:US
Practice Address - Phone:906-481-7652
Practice Address - Fax:906-481-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4900103322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty