Provider Demographics
NPI:1013132307
Name:BROWN, MICHELLE JACQUELINE (BSC, BED, OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JACQUELINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:BSC, BED, OD, FAAO
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:JACQUELINE
Other - Last Name:HOUDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 80686
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59108-0686
Mailing Address - Country:US
Mailing Address - Phone:406-245-2010
Mailing Address - Fax:
Practice Address - Street 1:1515 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3027
Practice Address - Country:US
Practice Address - Phone:406-245-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT733152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT84729Medicare ID - Type Unspecified