Provider Demographics
NPI:1568742229
Name:POQUETTE, AUDRY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:AUDRY
Middle Name:LYNN
Last Name:POQUETTE
Suffix:
Gender:F
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:200 FAIRBANKS ST
Mailing Address - Street 2:STE 1
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-1510
Mailing Address - Country:US
Mailing Address - Phone:906-774-8280
Mailing Address - Fax:906-774-8290
Practice Address - Street 1:200 FAIRBANKS ST
Practice Address - Street 2:STE 1
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-1510
Practice Address - Country:US
Practice Address - Phone:906-774-8280
Practice Address - Fax:906-774-8290
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901004657152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist