Individual
SUSAN MARIE MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
621 E LAKE ST, TAWAS CITY, MI 48763-9213
(989) 984-0929
(989) 984-0931
Mailing address
PO BOX 231, EAST TAWAS, MI 48730-0231
(989) 984-0929
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003215
MI
Other
Enumeration date
05/20/2008
Last updated
07/31/2009
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