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General NPI Number Information
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NPI Number | 1245672906
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Entity Type | Individual
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Provider Name | JULIE M POWELL OD
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Gender | Female
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 1170 JORDAN LAKE ST
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City | LAKE ODESSA
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State | MI
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Zip | 48849-1212
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Country | US
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Telephone | 616-374-3284
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Fax | 616-374-2020
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Provider Business Mailing Address
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Address Line | 702 W LAKE LANSING RD
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City | EAST LANSING
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State | MI
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Zip | 48823-8526
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Country | US
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Telephone | 517-337-1668
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Fax | 517-622-1205
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004772
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License Number State | MI
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