1750407177 NPI number — HOMER VISION CENTER INC.

Table of content: (NPI 1750407177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750407177 NPI number — HOMER VISION CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMER VISION CENTER INC.
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:
1750407177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49245-1023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-568-4411
Provider Business Mailing Address Fax Number:
517-568-3526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49245-1023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-568-4411
Provider Business Practice Location Address Fax Number:
517-568-3526
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STETLER
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTICIAN OWNER
Authorized Official Telephone Number:
517-568-4411

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: 52517 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2220046 . This is a "PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com