Individual
MARY SHULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
111 N HIGGINS AVE, SUITE 107, MISSOULA, MT 59802-4437
(406) 327-9988
(406) 541-9981
Mailing address
111 N HIGGINS AVE, SUITE 107, MISSOULA, MT 59802
(406) 327-9988
(406) 541-9981
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
BL01-556
MT
Other
Enumeration date
05/20/2015
Last updated
05/20/2015
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