Basic Information
| Provider Information | |||||||||
| NPI: | 1275159246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARINEAU | ||||||||
| FirstName: | OLIVIA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5848 BIRCHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LUDINGTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494319767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122519268 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5500 ARMSTRONG RD | ||||||||
| Address2: | |||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490377314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699665600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2020 | ||||||||
| LastUpdateDate: | 06/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901005428 | MI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.