Provider Demographics
NPI:1801966189
Name:MAIERS, MICHEL LUISE (OD)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:LUISE
Last Name:MAIERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHEL
Other - Middle Name:LUISE
Other - Last Name:PAWLOSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15697-1614
Mailing Address - Country:US
Mailing Address - Phone:724-925-2341
Mailing Address - Fax:724-925-2386
Practice Address - Street 1:310 N 3RD ST
Practice Address - Street 2:
Practice Address - City:YOUNGWOOD
Practice Address - State:PA
Practice Address - Zip Code:15697-1614
Practice Address - Country:US
Practice Address - Phone:724-925-2341
Practice Address - Fax:724-925-2386
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001263152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982887816OtherGROUP NPI
PA01973360Medicaid
1982887816OtherGROUP NPI
PA01973360Medicaid