Provider Demographics
NPI:1558522557
Name:OGLESBY, MICHELLE ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:ELIZABETH
Other - Last Name:EGENMAIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:213 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1445
Mailing Address - Country:US
Mailing Address - Phone:812-424-4444
Mailing Address - Fax:812-424-2200
Practice Address - Street 1:213 MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1445
Practice Address - Country:US
Practice Address - Phone:812-424-4444
Practice Address - Fax:812-424-2200
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003507A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist