Provider Demographics
NPI:1912542572
Name:BATES-FRIZZELL, MICHELE (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BATES-FRIZZELL
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SE OCEAN BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2426
Mailing Address - Country:US
Mailing Address - Phone:772-249-1038
Mailing Address - Fax:
Practice Address - Street 1:915 SE OCEAN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2426
Practice Address - Country:US
Practice Address - Phone:772-249-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5514156FX1800X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No332H00000XSuppliersEyewear Supplier