1548596695 NPI number — VISUALEYES CENTER OF VISUAL DEVELOPMENT, PLLC

Table of content: (NPI 1548596695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548596695 NPI number — VISUALEYES CENTER OF VISUAL DEVELOPMENT, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISUALEYES CENTER OF VISUAL DEVELOPMENT, PLLC
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:
1548596695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6231 138TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49423-9716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-751-4400
Provider Business Mailing Address Fax Number:
269-751-5365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3426 LINCOLN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49419-9512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-751-4400
Provider Business Practice Location Address Fax Number:
269-751-5365
Provider Enumeration Date:
10/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BURGESS
Authorized Official First Name:
LYNNETTE
Authorized Official Middle Name:
GAY
Authorized Official Title or Position:
OWNER/OPTOMETRIST
Authorized Official Telephone Number:
269-751-4400

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  4901003563 , 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)





Copyright © 2007-2025 www.npivalidator.com