Provider Demographics
NPI:1295749638
Name:KORCZ, MICHELLE DENISE (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DENISE
Last Name:KORCZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1835 GENERAL PERSHING ST
Mailing Address - Street 2:APT. #11
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-5456
Mailing Address - Country:US
Mailing Address - Phone:504-895-3247
Mailing Address - Fax:
Practice Address - Street 1:5300 FRERET ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6410
Practice Address - Country:US
Practice Address - Phone:504-891-1553
Practice Address - Fax:504-891-4163
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1305-441T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1434868Medicaid