1740361427 NPI number — KARI VISSER-ROBEL OD PC

Table of content: (NPI 1740361427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740361427 NPI number — KARI VISSER-ROBEL OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARI VISSER-ROBEL OD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740361427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAYLORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49734-5220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-705-1255
Provider Business Mailing Address Fax Number:
989-705-1476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
713 S WISCONSIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAYLORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49735-1766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-705-1255
Provider Business Practice Location Address Fax Number:
989-705-1476
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VISSER-ROBEL
Authorized Official First Name:
KARI
Authorized Official Middle Name:
MARTHA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-705-1255

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 410047657 . This is a "MEDICARE RR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com