Provider Demographics
NPI:1841711009
Name:CONRAD, MICHELLE T (OD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:CONRAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:T
Other - Last Name:TRINH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1400 COMMON DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5922
Mailing Address - Country:US
Mailing Address - Phone:915-595-4375
Mailing Address - Fax:915-595-4460
Practice Address - Street 1:1400 COMMON DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5922
Practice Address - Country:US
Practice Address - Phone:915-595-4375
Practice Address - Fax:915-595-4460
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9073TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist