Individual
MRS. JULIANA M WITHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
3209 MISHAWAKA AVE, SOUTH BEND, IN 46615-2335
(574) 234-7478
(574) 234-7478
Mailing address
3209 MISHAWAKA AVE, SOUTH BEND, IN 46615-2335
(574) 234-7478
(574) 234-7478
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
02/01/2010
Last updated
02/01/2010
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