Individual
DR. JULIE A MARVIN-MANDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
110 RIVERSIDE DR, MANCHESTER, MI 48158-9776
(734) 428-2020
(734) 428-8955
Mailing address
530 PENTECOST HWY, ONSTED, MI 49265-9604
(734) 260-5160
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003224
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H16788001
MEDICARE PTAN, INDIVIDUAL
MI
Enumeration date
05/31/2006
Last updated
12/23/2022
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