Individual
COURTNEY MOLITERNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
8470 MAIN ST, BIRCH RUN, MI 48415-9704
(989) 624-2020
(989) 624-6257
Mailing address
8470 MAIN ST, BIRCH RUN, MI 48415-9461
(989) 624-2020
(989) 624-6257
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004706
MI
152WC0802X
Corneal and Contact Management Optometrist
4901004706
MI
152WS0006X
Sports Vision Optometrist
4901004706
MI
152WV0400X
Vision Therapy Optometrist
4901004706
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19526639
HEALTHPLUS
MI
01
—
900G30405
BCBS
—
Enumeration date
06/14/2012
Last updated
09/17/2013
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