Individual
JACQUELYN LEE COSGROVE MALLEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2820 E BELTLINE LN NE, GRAND RAPIDS, MI 49525-9432
(616) 363-5413
Mailing address
2820 E BELTLINE LN NE, GRAND RAPIDS, MI 49525-9432
(616) 363-5413
(616) 363-4211
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901005682
MI
152W00000X
Optometrist
OD60861196
WA
Other
Enumeration date
05/11/2017
Last updated
01/30/2025
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