Provider Demographics
NPI:1528060795
Name:ESSEX, MICHELLE L (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:ESSEX
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 1:12075 E 45TH AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-3122
Mailing Address - Country:US
Mailing Address - Phone:303-371-2020
Mailing Address - Fax:303-371-8022
Practice Address - Street 1:12075 E 45TH AVE
Practice Address - Street 2:STE 210
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-3122
Practice Address - Country:US
Practice Address - Phone:303-371-2020
Practice Address - Fax:303-371-8022
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2325152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO509908Medicare ID - Type Unspecified
COU96780Medicare UPIN