Provider Demographics
NPI:1881926954
Name:WITHAM, JULIANA M (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:JULIANA
Middle Name:M
Last Name:WITHAM
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3209 MISHAWAKA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-2335
Mailing Address - Country:US
Mailing Address - Phone:574-234-7478
Mailing Address - Fax:574-234-7478
Practice Address - Street 1:3209 MISHAWAKA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-2335
Practice Address - Country:US
Practice Address - Phone:574-234-7478
Practice Address - Fax:574-234-7478
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician