Individual provider Active NPI

Michelle Lynn Wertelet, O.D.

  • Optometrist
  • Moon Township, PA
National Provider Identifier
1477577369
Registry record updated Jun 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG001764 Issued in PA
Practice address
1005 Beaver Grade Rd Ste G10
Moon Township, PA 15108-2964
Phone
(412) 308-9111
Fax
(412) 308-9112
NPI assigned
Jul 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG001764 PA Primary

Addresses

Primary practice location

1005 Beaver Grade Rd Ste G10
Moon Township, PA 15108-2964

Mailing address

1005 Beaver Grade Rd Ste G10
Moon Township, PA 15108-2964
Phone (412) 308-9111

Other identifiers 1

IdentifierTypeStateIssuer
1020734660001MedicaidPA

Other names 1

  • Dr. Michelle Lynn Anderson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081218000118 PA Practitioner - Optometry 6901830165 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1005 Beaver Grade Rd
Suite G10
Moon Township, PA 15108-2964
Phone (412) 308-9111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG001764PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Focus on Eyecare LLC Optometrist CurrentSince Aug 22, 2022 Accepting new patients

Locations

1005 Beaver Grade Rd
Ste G10
Moon Township, PA 15108
Phone (412) 308-9111

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1477577369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 BEAVER GRADE RD STE G10",
            "city": "MOON TOWNSHIP",
            "state": "PA",
            "postal_code": "151082964",
            "telephone_number": "412-308-9111",
            "fax_number": "412-308-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 BEAVER GRADE RD STE G10",
            "city": "MOON TOWNSHIP",
            "state": "PA",
            "postal_code": "151082964",
            "telephone_number": "412-308-9111",
            "fax_number": "412-308-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WERTELET",
        "first_name": "MICHELLE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG001764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020734660001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "ANDERSON",
            "middle_name": "LYNN",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Moon Township, PA

Sources for this page

Verify at the official NPI Registry.