Provider Demographics
NPI:1881774164
Name:KERR, MICHELLE FESSLER (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:FESSLER
Last Name:KERR
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 1:895 TRANCAS ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3040
Mailing Address - Country:US
Mailing Address - Phone:707-252-2020
Mailing Address - Fax:
Practice Address - Street 1:895 TRANCAS ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3040
Practice Address - Country:US
Practice Address - Phone:707-252-2020
Practice Address - Fax:707-252-0329
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9682T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU76512Medicare UPIN
CASD0096820Medicare PIN