Healthcare Provider Details

I. General information

NPI: 1538130703
Provider Name (Legal Business Name): MARY H ESPY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3541 MILLER RD
FLINT MI
48507-1235
US

IV. Provider business mailing address

G3541 MILLER RD
FLINT MI
48507-1235
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-8610
  • Fax:
Mailing address:
  • Phone: 810-732-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003627
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: