Provider Demographics
NPI:1134365927
Name:DEBORAH OSBORNE, O.D., PLLC
Entity type:Organization
Organization Name:DEBORAH OSBORNE, O.D., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-894-2488
Mailing Address - Street 1:504 E COLBY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1165
Mailing Address - Country:US
Mailing Address - Phone:231-894-2488
Mailing Address - Fax:231-893-3164
Practice Address - Street 1:504 E COLBY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1165
Practice Address - Country:US
Practice Address - Phone:231-894-2488
Practice Address - Fax:231-893-3164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003947152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1265OtherMEDICARE PTAN