Joanna M Deluco, O.D.
Individual provider Active NPI Optometrist · Marshall, MI
NPI 1194050989 · NPPES record last updated Oct 12, 2009
Key facts
- NPI
- 1194050989
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901004545 (MI)
- Practice address
- 14915 W Michigan Ave
Marshall, MI 49068-8504 - Phone
- (269) 781-9863
- Fax
- (269) 781-9864
- NPI assigned
- Oct 12, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901004545 | MI | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901004545 | MI | Yes |
Addresses
Primary practice location
14915 W Michigan Ave
Marshall, MI 49068-8504
Mailing address
14915 W Michigan Ave
Marshall, MI 49068-8504
Phone (269) 781-9863
Other providers in Marshall, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.