Provider Demographics
NPI:1760737175
Name:BROOKS, MICHELLE L (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2672 DAVID H MCLEOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4042
Mailing Address - Country:US
Mailing Address - Phone:843-773-2758
Mailing Address - Fax:843-432-3189
Practice Address - Street 1:2672 DAVID H MCLEOD BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4042
Practice Address - Country:US
Practice Address - Phone:843-773-2758
Practice Address - Fax:843-432-3189
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist