Individual
KELLY L BULOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
559 PROGRESS ST STE E, WEST BRANCH, MI 48661-9399
(989) 345-8113
(893) 457-4849
Mailing address
559 PROGRESS ST STE E, WEST BRANCH, MI 48661-9399
(989) 345-8113
(893) 457-4849
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003860
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
944529185
—
MI
Enumeration date
08/13/2006
Last updated
02/05/2021
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