1588993422 NPI number — CORNERSTONE OPTOMETRY PLLC

Table of content: (NPI 1588993422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588993422 NPI number — CORNERSTONE OPTOMETRY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE OPTOMETRY 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:
6
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:
1588993422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 BLISSFIELD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTON SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49441-4413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-733-5530
Provider Business Mailing Address Fax Number:
231-733-5585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3285 HENRY ST
Provider Second Line Business Practice Location Address:
TODD J. RIKER, O.D. / VISION CENTER
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49441-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-739-4728
Provider Business Practice Location Address Fax Number:
231-739-4730
Provider Enumeration Date:
12/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RIKER
Authorized Official First Name:
TODD
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
231-733-5530

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901004230 , 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