Provider Demographics
NPI:1861621138
Name:WOOLF, MICHELLE LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:WOOLF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:PINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:600 NE CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-3084
Mailing Address - Country:US
Mailing Address - Phone:816-224-3838
Mailing Address - Fax:816-224-6379
Practice Address - Street 1:600 NE CORONADO DR
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-3084
Practice Address - Country:US
Practice Address - Phone:816-224-3838
Practice Address - Fax:816-224-6379
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009018519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist