Provider Demographics
NPI:1629388301
Name:FEKETE, MICHELLE DIANE (OD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
Last Name:FEKETE
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 1:10441 LIGHTNER BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1815
Mailing Address - Country:US
Mailing Address - Phone:901-849-4148
Mailing Address - Fax:
Practice Address - Street 1:2747 GULF TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-3945
Practice Address - Country:US
Practice Address - Phone:727-726-3207
Practice Address - Fax:727-431-0236
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC004574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist