Basic Information
| Provider Information | |||||||||
| NPI: | 1245544949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULANIX | ||||||||
| FirstName: | GERIANNE | ||||||||
| MiddleName: | JOHANNA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | OD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SMECKERT | ||||||||
| OtherFirstName: | GERIANNE | ||||||||
| OtherMiddleName: | JOHANNA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 123 E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | LINDEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484519126 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4499 TOWN CENTER PKWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107337111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2010 | ||||||||
| LastUpdateDate: | 02/13/2017 | ||||||||
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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 | 4901004592 | MI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.