Provider Demographics
NPI:1104497981
Name:NAGRO, MICHELLE WEST (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:WEST
Last Name:NAGRO
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 1:221 BRAGDON AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-6549
Mailing Address - Country:US
Mailing Address - Phone:843-240-7505
Mailing Address - Fax:
Practice Address - Street 1:302 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2406
Practice Address - Country:US
Practice Address - Phone:843-546-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist