Provider Demographics
NPI:1568284578
Name:MICHELLE BLEW, O.D., LLC
Entity type:Organization
Organization Name:MICHELLE BLEW, O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LAUREN ZICKEL
Authorized Official - Last Name:BLEW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-631-3404
Mailing Address - Street 1:183 PORT RD STE B
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7735
Mailing Address - Country:US
Mailing Address - Phone:207-216-9937
Mailing Address - Fax:207-216-9939
Practice Address - Street 1:183 PORT RD STE B
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7735
Practice Address - Country:US
Practice Address - Phone:207-216-9937
Practice Address - Fax:207-216-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty