Provider Demographics
NPI:1841275450
Name:MICHEL, BEATRICE H (OD)
Entity type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:H
Last Name:MICHEL
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 1:800 MAIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-3760
Mailing Address - Country:US
Mailing Address - Phone:503-842-5568
Mailing Address - Fax:503-842-1122
Practice Address - Street 1:800 MAIN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3814
Practice Address - Country:US
Practice Address - Phone:503-842-5568
Practice Address - Fax:503-842-1122
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1932AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR001201Medicaid
OR001201Medicaid
OROOWCPCWBMedicare PIN