Provider Demographics
NPI:1912990425
Name:NAVE, MICHELLE M (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:M
Last Name:NAVE
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 1:14643 MERCANTILE DR N STE 112
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-4632
Mailing Address - Country:US
Mailing Address - Phone:651-426-3630
Mailing Address - Fax:651-426-4014
Practice Address - Street 1:120 MARTIN DRIVE
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:WI
Practice Address - Zip Code:53021-2408
Practice Address - Country:US
Practice Address - Phone:262-692-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38609500Medicaid
WI7419074OtherAETNA
U70301Medicare UPIN