MEDICARE: JULIANA POSSO LDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	003218	AZ

General Provider Information

NPI Number	:	1366135238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANA POSSO LDO

Provider Business Mailing Address
First Line	:	5695 HIGHWAY 95 N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-9646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5695 HIGHWAY 95 N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-9646
Country	:	US
Telephone Number	:	928-764-3755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2023
Last Update Date	:	05/29/2023

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Directions to “ JULIANA POSSO LDO” Practice Location

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