Provider Demographics
NPI:1932107620
Name:COTE-BRZOZA, MICHELLE L (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:COTE-BRZOZA
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 1:1185 SHELBURNE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7362
Mailing Address - Country:US
Mailing Address - Phone:802-862-0023
Mailing Address - Fax:802-862-0665
Practice Address - Street 1:1185 SHELBURNE RD STE 5
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7362
Practice Address - Country:US
Practice Address - Phone:802-862-0023
Practice Address - Fax:802-862-0665
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000293152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2436Medicaid
U82347Medicare UPIN
0496270001Medicare NSC
VN2436Medicare PIN