Provider Demographics
NPI:1215969639
Name:KOCH, PAULA ELAINE (OD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ELAINE
Last Name:KOCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:ELAINE
Other - Last Name:CHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:314 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1280
Mailing Address - Country:US
Mailing Address - Phone:734-475-3800
Mailing Address - Fax:734-475-3821
Practice Address - Street 1:314 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1280
Practice Address - Country:US
Practice Address - Phone:734-475-3800
Practice Address - Fax:734-475-3821
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6183950001Medicare NSC
MI6183950001Medicare PIN