Provider Demographics
NPI:1760440382
Name:HARPER, MICHELLE MARIE (O D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:HARPER
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3819
Mailing Address - Country:US
Mailing Address - Phone:920-743-8884
Mailing Address - Fax:920-743-2519
Practice Address - Street 1:1236 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3819
Practice Address - Country:US
Practice Address - Phone:920-743-8884
Practice Address - Fax:920-743-2519
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2548-075152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38603600Medicaid
WI1244500001Medicare NSC
WI38603600Medicaid
WI000135157Medicare PIN