Provider Demographics
NPI:1295885184
Name:TURLAIS, MICHELLE S (OD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:TURLAIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10340 S KELLY DR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-7938
Mailing Address - Country:US
Mailing Address - Phone:414-764-6031
Mailing Address - Fax:
Practice Address - Street 1:5778 DURAND AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5040
Practice Address - Country:US
Practice Address - Phone:414-554-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2813152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU882389Medicare UPIN