Provider Demographics
NPI:1518145069
Name:SANTIAGO, JULIE LINN
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LINN
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CANISTEO
Mailing Address - State:NY
Mailing Address - Zip Code:14823-1303
Mailing Address - Country:US
Mailing Address - Phone:607-698-2541
Mailing Address - Fax:
Practice Address - Street 1:7 ERIE AVE
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1909
Practice Address - Country:US
Practice Address - Phone:607-324-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007858-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician