Provider Demographics
NPI:1629064944
Name:MICHAUD, NORMAN G (OD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:G
Last Name:MICHAUD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-1708
Mailing Address - Country:US
Mailing Address - Phone:603-497-3622
Mailing Address - Fax:603-497-5325
Practice Address - Street 1:24 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-1708
Practice Address - Country:US
Practice Address - Phone:603-497-3622
Practice Address - Fax:603-497-5325
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2009-11-17
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
NH210152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH020443084OtherINDEPENDENT INSURANCE PIN
NH73020OtherCIGNA PIN
NH0906096YONH01OtherANTHEM BC/BS PIN
NH1051326OtherHARVARD PILGRIM PIN
NHNH7835Medicare ID - Type UnspecifiedOPTOMETRIST
NH0906096YONH01OtherANTHEM BC/BS PIN
NHP00072272Medicare PIN