Provider Demographics
NPI:1790058345
Name:MICHEL, PAUL BRENT (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRENT
Last Name:MICHEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6247 W PRENTICE AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-5194
Mailing Address - Country:US
Mailing Address - Phone:303-723-0638
Mailing Address - Fax:
Practice Address - Street 1:6247 W PRENTICE AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-5194
Practice Address - Country:US
Practice Address - Phone:303-723-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1617152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist