Active NPI
Marian Victoria Wardell, O.D.
- Optometrist
- Ann Arbor, MI
National Provider Identifier
1457584328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901004548
- Practice address
- 3601 Washtenaw Ave
Suite E
Ann Arbor, MI 48104-5277 - Phone
- (734) 973-1969
- NPI assigned
- Aug 26, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901004548 | MI | Primary |
Addresses
Primary practice location
3601 Washtenaw Ave
Suite E
Ann Arbor, MI 48104-5277
Mailing address
22009 Shore Pointe LN
Saint Clair Shores, MI 48080-3576
Phone (772) 233-5959
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901004548 | MI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251244800000",
"number": "1457584328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22009 SHORE POINTE LN",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480803576",
"telephone_number": "772-233-5959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 WASHTENAW AVE",
"address_2": "SUITE E",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481045277",
"telephone_number": "734-973-1969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARDELL",
"first_name": "MARIAN",
"middle_name": "VICTORIA",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-26",
"last_updated": "2009-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901004548",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.