Provider Demographics
NPI:1245455641
Name:MICHELLE L. CAZETT O. D. P. C.
Entity type:Organization
Organization Name:MICHELLE L. CAZETT O. D. P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CAZETT
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:641-753-3169
Mailing Address - Street 1:4909 HIGHWAY S74 S
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-8426
Mailing Address - Country:US
Mailing Address - Phone:641-753-3169
Mailing Address - Fax:
Practice Address - Street 1:2802 S CENTER ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4708
Practice Address - Country:US
Practice Address - Phone:641-753-3169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1181941Medicaid
IA43263OtherBLUE CROSS
IA43263OtherBLUE CROSS
IA1181941Medicaid
IAI13087Medicare ID - Type UnspecifiedINDIVIDUAL