Provider Demographics
NPI:1477673515
Name:LUNN, JULIE MARCELLA (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MARCELLA
Last Name:LUNN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PEPPERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7381
Mailing Address - Country:US
Mailing Address - Phone:303-349-5795
Mailing Address - Fax:
Practice Address - Street 1:167 HOGAN BLVD
Practice Address - Street 2:
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-1902
Practice Address - Country:US
Practice Address - Phone:570-893-8286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU92448Medicare UPIN
COC477958Medicare ID - Type Unspecified