Provider Demographics
NPI:1750475000
Name:CHEN, MICHELLE T (OD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:CHEN
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 1:3307 SW 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7843
Mailing Address - Country:US
Mailing Address - Phone:352-861-3940
Mailing Address - Fax:352-861-3941
Practice Address - Street 1:3307 SW 26TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7843
Practice Address - Country:US
Practice Address - Phone:352-861-3940
Practice Address - Fax:352-861-3965
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200416549152W00000X
TX06577T152W00000X
FLOPC4194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist