Individual
DR. JENNIFER MAZZOLA SORTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2433 OAK VALLEY DR, SUITE 300, ANN ARBOR, MI 48103-7602
(734) 994-0100
(734) 994-9625
Mailing address
2433 OAK VALLEY DR, SUITE 300, ANN ARBOR, MI 48103-7602
(734) 994-0100
(734) 994-9625
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004033
MI
152WP0200X
Pediatric Optometrist
4901004033
MI
152WS0006X
Sports Vision Optometrist
4901004033
MI
152WV0400X
Vision Therapy Optometrist
4901004033
MI
152WX0102X
Occupational Vision Optometrist
4901004033
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4175195
—
MI
01
—
JS004033
BCBS MICHIGAN
MI
Enumeration date
08/22/2005
Last updated
11/20/2007
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