Provider Demographics
NPI:1881863546
Name:STORER, JULIE NEILITZ (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:NEILITZ
Last Name:STORER
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 1:936 HAMPSHIRE HEATH DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8366
Mailing Address - Country:US
Mailing Address - Phone:636-294-4984
Mailing Address - Fax:
Practice Address - Street 1:2512 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6625
Practice Address - Country:US
Practice Address - Phone:636-281-8818
Practice Address - Fax:636-281-8817
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004082152W00000X
MO2003030798152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO258224456Medicare UPIN