Provider Demographics
NPI:1245544949
Name:MULANIX, GERIANNE JOHANNA (OD)
Entity type:Individual
Prefix:
First Name:GERIANNE
Middle Name:JOHANNA
Last Name:MULANIX
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:GERIANNE
Other - Middle Name:JOHANNA
Other - Last Name:SMECKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-9126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4499 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3425
Practice Address - Country:US
Practice Address - Phone:810-733-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist