Provider Demographics
NPI:1154735348
Name:GENRICH, WHITNEY (OD)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:GENRICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:317 S ELM ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2636
Mailing Address - Country:US
Mailing Address - Phone:989-723-1101
Mailing Address - Fax:
Practice Address - Street 1:317 S ELM ST
Practice Address - Street 2:SUITE 210
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2636
Practice Address - Country:US
Practice Address - Phone:989-723-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist