Provider Demographics
NPI:1811070642
Name:MICHAUD, JEFFREY P (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:MICHAUD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-1708
Mailing Address - Country:US
Mailing Address - Phone:603-497-3622
Mailing Address - Fax:603-497-5325
Practice Address - Street 1:24 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-1708
Practice Address - Country:US
Practice Address - Phone:603-497-3622
Practice Address - Fax:603-497-5325
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0645152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH11364276OtherCAQH