Individual
MICHELLE ELIZABETH TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4243 4TH AVE S, MINNEAPOLIS, MN 55409-2113
(612) 821-2003
Mailing address
4243 4TH AVE S, MINNEAPOLIS, MN 55409-2113
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2605
MN
152WV0400X
Vision Therapy Optometrist
2605
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
592325500
—
MN
Enumeration date
07/07/2006
Last updated
10/14/2020
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