Provider Demographics
NPI:1518172287
Name:STANLEY, MICHELE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:RASHID-STANLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1542 THOMAS CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1623
Mailing Address - Country:US
Mailing Address - Phone:304-344-0162
Mailing Address - Fax:304-769-2254
Practice Address - Street 1:100 NITRO MARKET PL
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-4401
Practice Address - Country:US
Practice Address - Phone:304-769-2253
Practice Address - Fax:304-769-2254
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV851OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0619845OtherPTAN
WV0619845OtherPTAN
WVST0619845Medicare PIN