Provider Demographics
NPI:1356234033
Name:RAAD, MICHELE (OD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:RAAD
Suffix:
Gender:X
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 WILLOWGLEN DR
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-3622
Mailing Address - Country:US
Mailing Address - Phone:626-234-0577
Mailing Address - Fax:
Practice Address - Street 1:30080 HAUN RD SPC P2
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-6817
Practice Address - Country:US
Practice Address - Phone:951-301-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist