Healthcare Provider Details

I. General information

NPI: 1932735412
Provider Name (Legal Business Name): JULIE HULEIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 09/28/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 TEAYS VALLEY RD
HURRICANE WV
25526-9645
US

IV. Provider business mailing address

5701 GREENBELT RD
BERWYN HEIGHTS MD
20740-2257
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-2533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2754
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3007-IOD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: