Provider Demographics
NPI:1134183932
Name:SPITTLER, MICHELLE L (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:SPITTLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-314-9760
Mailing Address - Fax:803-314-9761
Practice Address - Street 1:2728 SUNSET BLVD STE 106
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4836
Practice Address - Country:US
Practice Address - Phone:803-314-9760
Practice Address - Fax:803-314-9761
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD10824Medicaid
SCD10824Medicaid