Provider Demographics
NPI:1962601625
Name:VAN DEN TOP, MICHELLE LARAE (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LARAE
Last Name:VAN DEN TOP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:110 GAUL DR
Mailing Address - Street 2:STE B
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054
Mailing Address - Country:US
Mailing Address - Phone:712-943-9400
Mailing Address - Fax:712-943-9403
Practice Address - Street 1:110 GAUL DR
Practice Address - Street 2:STE B
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054
Practice Address - Country:US
Practice Address - Phone:712-943-9400
Practice Address - Fax:712-943-9403
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist