Healthcare Provider Details

I. General information

NPI: 1386085876
Provider Name (Legal Business Name): LIZBETH ANN JOSEPH O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33100 S GRATIOT AVE
CLINTON TWP MI
48035-4036
US

IV. Provider business mailing address

735 JOHN R RD STE 150
TROY MI
48083-5859
US

V. Phone/Fax

Practice location:
  • Phone: 586-294-0120
  • Fax: 586-294-6322
Mailing address:
  • Phone: 248-588-9300
  • Fax: 248-588-9917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6209
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003868
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004844
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: