Basic Information
| Provider Information | |||||||||
| NPI: | 1699227397 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARGRITZ | ||||||||
| FirstName: | TABITHA | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 363 HARBOR TOWN CT | ||||||||
| Address2: | #2 | ||||||||
| City: | HOLLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494239226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855775907 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2279 N PARK DRIVE #910 | ||||||||
| Address2: | |||||||||
| City: | HOLLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165102243 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2016 | ||||||||
| LastUpdateDate: | 10/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901005019 | MI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.