| NPI | 1568136349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCI L CHARLAND Credentialing Coordinator 231-638-1853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207WX0109X Ophthalmology, Neuro-ophthalmology |
| Additional Taxonomies | 207WX0110X Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist |
| 207W00000X Ophthalmology | |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2023-10-20 |