Individual
JULIE LYNN SAMU SHOULDICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
6494 LINK BLVD, INDIAN RIVER, MI 49749-9784
(313) 539-2020
Mailing address
6494 LINK BLVD, INDIAN RIVER, MI 49749-9784
(313) 539-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004074
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0585020001
ADMINASTAR
MI
01
—
0N16830
MEDICARE PLUS BLUE
MI
01
—
4100442401
RAILROAD MEDICARE
MI
05
—
4236737
—
MI
01
—
900F965090
BCBS
MI
Enumeration date
11/01/2006
Last updated
11/16/2016
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