Individual
MRS. MICHELE COSTANZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10074 STATION RD, COLUMBIA STATION, OH 44028-9594
(440) 236-3937
Mailing address
10074 STATION RD, COLUMBIA STATION, OH 44028-9594
(440) 236-3937
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
4133-S
OH
Other
Enumeration date
06/08/2012
Last updated
06/08/2012
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