Provider Demographics
NPI:1699227397
Name:MARGRITZ, TABITHA (OD)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:MARGRITZ
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 1:363 HARBOR TOWN CT
Mailing Address - Street 2:#2
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9226
Mailing Address - Country:US
Mailing Address - Phone:785-577-5907
Mailing Address - Fax:
Practice Address - Street 1:2279 N PARK DRIVE #910
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424
Practice Address - Country:US
Practice Address - Phone:616-510-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist