1316067960 NPI number — DAWN MACCREERY OD

Table of content: (NPI 1316067960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316067960 NPI number — DAWN MACCREERY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAWN MACCREERY OD
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:
MACCREERY VISION CENTER
Provider Other Organization Name Type Code:
3
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:
1316067960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3050 E LAKE LANSING RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
EAST LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-332-1011
Provider Business Mailing Address Fax Number:
517-332-6321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3050 E LAKE LANSING RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-332-1011
Provider Business Practice Location Address Fax Number:
517-332-6321
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MACCREERY
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
YVONNE
Authorized Official Title or Position:
OPTOMETRIST OWNER
Authorized Official Telephone Number:
517-332-1011

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901002817 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MI2817001 . This is a "EYEMED" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 900C36566 . This is a "BLUE CROSS BLUE SHIELD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5585771 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: M3050366644010 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 877935 . This is a "OPTICHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P58720 . This is a "BCN HEALTH CENTRAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 023437 . This is a "NVA HERITAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000005797 . This is a "PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com