Individual
JONELLE OLIVIA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
10401 BENNETT RD, FREDONIA, NY 14063-1402
(716) 679-3180
Mailing address
1816 W 24TH ST, ERIE, PA 16502-2022
(954) 559-1957
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV008716
NY
Other
Enumeration date
01/19/2018
Last updated
01/19/2018
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