Provider Demographics
NPI:1225025513
Name:PALAZZOLO, MICHELE R (OD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:R
Last Name:PALAZZOLO
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 1:300 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4447
Mailing Address - Country:US
Mailing Address - Phone:401-463-3500
Mailing Address - Fax:401-739-9670
Practice Address - Street 1:300 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4447
Practice Address - Country:US
Practice Address - Phone:401-463-3500
Practice Address - Fax:401-739-9670
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist