1881814630 NPI number — ALLENDALE EYE CARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881814630 NPI number — ALLENDALE EYE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLENDALE EYE CARE, LLC
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:
1881814630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11301 COMMERCE RD.
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
ALLENDALE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-895-9550
Provider Business Mailing Address Fax Number:
616-892-5166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11301 COMMERCE RD.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ALLENDALE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-895-9550
Provider Business Practice Location Address Fax Number:
616-892-5166
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSLUND
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OPTOMETRIST, LLC MANAGER
Authorized Official Telephone Number:
616-895-9550

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , 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)





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