Provider Demographics
NPI:1124053954
Name:DENTON, DEBRA LIN (OD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LIN
Last Name:DENTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:LIN
Other - Last Name:DENTON-CARLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:932 SPRING ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2286
Mailing Address - Country:US
Mailing Address - Phone:231-487-5315
Mailing Address - Fax:231-487-5316
Practice Address - Street 1:932 SPRING ST STE 101
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2286
Practice Address - Country:US
Practice Address - Phone:231-487-5315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4929006Medicaid
MI38-3569181OtherCOMMERCIAL
MI4929006Medicaid
MI0B40013OtherBCBS MI