Provider Demographics
NPI:1487745741
Name:LETSON, MARIE C (OD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:C
Last Name:LETSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:L
Other - Last Name:BOURLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2801 MEMORIAL PKWY SW
Mailing Address - Street 2:SUITE #193
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6519
Mailing Address - Country:US
Mailing Address - Phone:256-534-8423
Mailing Address - Fax:256-534-8511
Practice Address - Street 1:2801 MEMORIAL PKWY SW
Practice Address - Street 2:SUITE #193
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6519
Practice Address - Country:US
Practice Address - Phone:256-534-8423
Practice Address - Fax:256-534-8511
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-863-TA-404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51527060OtherBLUE CROSS & BLUE SHIELD
AL51527060OtherBLUE CROSS & BLUE SHIELD