Provider Demographics
NPI:1548205172
Name:CAZETT, MICHELLE LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEE
Last Name:CAZETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 HWY S74 S
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208
Mailing Address - Country:US
Mailing Address - Phone:641-753-3169
Mailing Address - Fax:641-753-6758
Practice Address - Street 1:2802 S CENTER ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158
Practice Address - Country:US
Practice Address - Phone:641-753-3169
Practice Address - Fax:641-753-6758
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1181941Medicaid
24821OtherSPECTARA
IA43263OtherBCBS
34692OtherAVESIS
48003OtherDAVIS
U73480Medicare UPIN
34692OtherAVESIS
I13085Medicare ID - Type UnspecifiedGROUP