Provider Demographics
NPI:1962184002
Name:COX, MICHELLE RANDALL
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RANDALL
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:DILLWYN
Mailing Address - State:VA
Mailing Address - Zip Code:23936-2665
Mailing Address - Country:US
Mailing Address - Phone:434-960-9308
Mailing Address - Fax:
Practice Address - Street 1:2206 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:DILLWYN
Practice Address - State:VA
Practice Address - Zip Code:23936-2665
Practice Address - Country:US
Practice Address - Phone:434-960-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004161156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician