Provider Demographics
NPI:1053426866
Name:MICHEL, VANESSA G (OD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:G
Last Name:MICHEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:G
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:23535 NE NOVELTY HILL RD
Mailing Address - Street 2:D302
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-5502
Mailing Address - Country:US
Mailing Address - Phone:425-898-9222
Mailing Address - Fax:253-854-2020
Practice Address - Street 1:23535 NE NOVELTY HILL RD
Practice Address - Street 2:D302
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-5502
Practice Address - Country:US
Practice Address - Phone:425-898-9222
Practice Address - Fax:253-854-2020
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0213556OtherLABOR & INDUSTRIES
WAP00397181OtherRAILROAD MEDICARE INDIVIDUAL
WA2029585Medicaid
WADF8532OtherRAILROAD MEDICARE GROUP
WADF8532OtherRAILROAD MEDICARE GROUP
WA2029585Medicaid
WA5819440001Medicare NSC
WA5819440003Medicare NSC
WA0213556OtherLABOR & INDUSTRIES