Provider Demographics
NPI:1235970278
Name:SOWARD, MARYMICHELLE (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:MARYMICHELLE
Middle Name:
Last Name:SOWARD
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:MARYMICHELLE
Other - Middle Name:
Other - Last Name:RIFFLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100A E WASHINGTON JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9729
Mailing Address - Country:US
Mailing Address - Phone:937-456-2722
Mailing Address - Fax:937-456-4340
Practice Address - Street 1:100A E WASHINGTON JACKSON RD
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9729
Practice Address - Country:US
Practice Address - Phone:937-456-2722
Practice Address - Fax:937-456-4340
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.017738-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician