Provider Demographics
NPI:1922664564
Name:NISHKU, MICHELLE TRAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:TRAN
Last Name:NISHKU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ANNA
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:8231 BRIER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7705
Practice Address - Country:US
Practice Address - Phone:919-863-5032
Practice Address - Fax:919-863-5038
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002747152W00000X
NC2712152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist