Provider Demographics
NPI:1902025430
Name:ALCALA, MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:ALCALA
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 1:357 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3284
Mailing Address - Country:US
Mailing Address - Phone:732-972-2221
Mailing Address - Fax:732-972-1195
Practice Address - Street 1:357 ROUTE 9
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3284
Practice Address - Country:US
Practice Address - Phone:732-972-2221
Practice Address - Fax:732-972-1195
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA5470152W00000X
NJTO1140152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075252QSAMedicare ID - Type Unspecified
NJU97704Medicare UPIN