Provider Demographics
NPI:1356358493
Name:STUTZMAN FAULKNER, JULIE ANN (OD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:STUTZMAN FAULKNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:STUTZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1805 STATE HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-9011
Mailing Address - Country:US
Mailing Address - Phone:870-739-4727
Mailing Address - Fax:
Practice Address - Street 1:1805 STATE HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-9011
Practice Address - Country:US
Practice Address - Phone:870-739-2020
Practice Address - Fax:870-739-2939
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135204722Medicaid
ARU69877Medicare UPIN