=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881303956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARTLAND FAMILY VISION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2022
-----------------------------------------------------
Last Update Date | 11/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 N LINCOLN RD
-----------------------------------------------------
City | ESCANABA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49829-1326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-798-0668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 312 N LINCOLN RD
-----------------------------------------------------
City | ESCANABA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49829-1326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | LEANNE ALEXIS GARTLAND
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 906-241-7428
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------