Provider Demographics
NPI:1831486935
Name:CONRAD, JOSEPH SAMUEL (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SAMUEL
Last Name:CONRAD
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1191 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1005
Mailing Address - Country:US
Mailing Address - Phone:517-546-4655
Mailing Address - Fax:517-546-0899
Practice Address - Street 1:1191 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1005
Practice Address - Country:US
Practice Address - Phone:517-546-4655
Practice Address - Fax:517-546-0899
Is Sole Proprietor?:No
Enumeration Date:2011-07-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6639430001Medicare NSC