Provider Demographics
NPI:1568515674
Name:ANDERS, MICHELLE PAIGE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:PAIGE
Last Name:ANDERS
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 1:4592 WALDON POND LN
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-4100
Mailing Address - Country:US
Mailing Address - Phone:606-224-0384
Mailing Address - Fax:
Practice Address - Street 1:1403 CUMBERLAND AVE
Practice Address - Street 2:STE A
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1158
Practice Address - Country:US
Practice Address - Phone:606-248-2549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1612DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00421Medicare UPIN