Individual
MARIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4281 24TH AVE, FORT GRATIOT, MI 48059-3997
(810) 385-4000
Mailing address
6401 BURTCH RD, JEDDO, MI 48032-2720
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901005688
MI
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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