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NPI Code Detail

MEDICARE: DEANNA LYN MAYO O.D.

MEDICARE: DEANNA LYN MAYO O.D.
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
1152W00000XOptometrist4901004152MI

General Provider Information

NPI Number : 1588677868
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA LYN MAYO O.D.
Provider Business Mailing Address
First Line : 100 NORTH AVE
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49017-3417
Country : US
Telephone Number : 269-962-7595
Fax Number : 269-963-9202
Provider Business Practice Location Address
First Line : 100 NORTH AVE
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49017-3417
Country : US
Telephone Number : 269-962-7595
Fax Number : 269-963-9202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 07/08/2007

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Directions to “ DEANNA LYN MAYO O.D.” Practice Location

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