Provider Demographics
NPI:1629127964
Name:SHADE-HINCHLIFFE, MICHELE Y (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:Y
Last Name:SHADE-HINCHLIFFE
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 1:142 SHOEMAKER RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-6430
Mailing Address - Country:US
Mailing Address - Phone:610-326-1106
Mailing Address - Fax:610-326-1108
Practice Address - Street 1:142 SHOEMAKER RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-6430
Practice Address - Country:US
Practice Address - Phone:610-326-1106
Practice Address - Fax:610-326-1108
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000169152W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0514846000OtherKEYSTONE EAST
PA28837OtherAETNA
PA000680822OtherINDEPENDENCE BLUE CROSS
PA0514846000OtherKEYSTONE EAST
PA2033090001Medicare NSC
PAU19400Medicare UPIN