Provider Demographics
NPI:1649256629
Name:CADET-HONORE, MICHELLE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:CADET-HONORE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2254 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-3714
Mailing Address - Country:US
Mailing Address - Phone:215-634-7451
Mailing Address - Fax:215-634-7491
Practice Address - Street 1:2254 N FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19133-3714
Practice Address - Country:US
Practice Address - Phone:215-634-7451
Practice Address - Fax:215-634-7491
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01755404Medicaid
PAU90104Medicare UPIN
PA057672Medicare ID - Type Unspecified