Provider Demographics
NPI:1104904481
Name:VENEZIANO, MICHELLE LYNN (OD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:VENEZIANO
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 1:3045 NOE BIXBY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5851
Mailing Address - Country:US
Mailing Address - Phone:614-837-3797
Mailing Address - Fax:614-837-9494
Practice Address - Street 1:3045 NOE BIXBY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-5851
Practice Address - Country:US
Practice Address - Phone:614-837-3797
Practice Address - Fax:614-837-9494
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5344152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2347544Medicaid
OHVE4091541Medicare PIN
OHU91791Medicare UPIN
OH2347544Medicaid