Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | JL003989 | MI |
NPI | 1003992082 |
---|---|
Provider Name | Jennifer Ann Lintz |
First Address | Traverse City, MI 49686-8683 |
Second Address | Traverse City, MI 49686 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 20/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4154435 | (05) | MI |
G38287 | (02) | MI |