Provider Demographics
NPI:1386085876
Name:JOSEPH, LIZBETH ANN (OD)
Entity type:Individual
Prefix:
First Name:LIZBETH
Middle Name:ANN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 JOHN R RD STE 150
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5859
Mailing Address - Country:US
Mailing Address - Phone:248-588-9300
Mailing Address - Fax:248-588-9917
Practice Address - Street 1:33100 S GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-4036
Practice Address - Country:US
Practice Address - Phone:586-294-0120
Practice Address - Fax:586-294-6322
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6209152W00000X
IN18003868152W00000X
MI4901004844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty