1841483989 NPI number — THORNAPPLE OPHTHALMOLOGY THORNAPPLE OPHTHALMOLOGY ASSOC PC

Table of content: (NPI 1841483989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841483989 NPI number — THORNAPPLE OPHTHALMOLOGY THORNAPPLE OPHTHALMOLOGY ASSOC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THORNAPPLE OPHTHALMOLOGY THORNAPPLE OPHTHALMOLOGY ASSOC PC
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:
1841483989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1335 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49331-1555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-897-7000
Provider Business Mailing Address Fax Number:
616-897-5604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1335 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49331-1555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-897-7000
Provider Business Practice Location Address Fax Number:
616-897-5604
Provider Enumeration Date:
08/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLOHR
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
616-897-7000

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901004379 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 4901004439 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 4901004379 , 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