| NPI | 1417137084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENE ERNEST FONGER Store Owner 616-459-0641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: MI 4901004219) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901002505) |
| 152WV0400X Optometrist, Vision Therapy (Licence: MI 4901004219) | |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2016-06-30 |