Provider Demographics
NPI:1922187178
Name:WITT, JULIE MARIE (OD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:WITT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:GRUVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1133 COLLEGE AVE STE D156
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2784
Mailing Address - Country:US
Mailing Address - Phone:785-537-3937
Mailing Address - Fax:785-537-2914
Practice Address - Street 1:1133 COLLEGE AVE STE D156
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2784
Practice Address - Country:US
Practice Address - Phone:785-537-3937
Practice Address - Fax:785-537-2914
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist