| NPI | 1154454411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS WHEATON Billing Specialist 616-285-3700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI RP004201) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI AD004260) |
| 207W00000X Ophthalmology (Licence: MI BB2701301) | |
| 207W00000X Ophthalmology (Licence: MI DD014374) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-08-22 |