Provider Demographics
NPI:1063417517
Name:HIGGINS, MICHELLE L (OD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:HIGGINS
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 1:26 SCHOOL ST
Mailing Address - Street 2:STE 1
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-4710
Mailing Address - Country:US
Mailing Address - Phone:207-847-3800
Mailing Address - Fax:207-847-3802
Practice Address - Street 1:26 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-4709
Practice Address - Country:US
Practice Address - Phone:207-854-1544
Practice Address - Fax:207-854-1516
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT873152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME3559581OtherAETNA
ME412330099Medicaid
ME1689835845OtherGROUP NPI #
ME023030OtherANTHEMBCBS
ME3559581OtherAETNA
MEU89275Medicare UPIN