Provider Demographics
NPI:1982783064
Name:MICHELS, DENNIS LLOYD (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LLOYD
Last Name:MICHELS
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 1:1007 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-3613
Mailing Address - Country:US
Mailing Address - Phone:252-523-2020
Mailing Address - Fax:252-522-4212
Practice Address - Street 1:1007 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-3613
Practice Address - Country:US
Practice Address - Phone:252-523-2020
Practice Address - Fax:252-522-4212
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC839152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902008Medicaid
NCMM0227632OtherDEA
246262BMedicare ID - Type Unspecified
NC8902008Medicaid