Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 334 N Ross, Beaverton, Michigan |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1477738961 | NPI | - | NPPES |
900A86500 | Other | MI | BC/BS |
1908862 | Medicaid | MI | |
410008233 | Other | MI | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 4901003085 (Michigan) | Primary |
332H00000X | Eyewear Supplier | 003085 (Michigan) | Secondary |
332H00000X | Eyewear Supplier | 004640 (Michigan) | Secondary |
Mailing Address | Practice Location Address |
---|---|
1520 B N Mcewan St, Clare, MI 48617 Ph: (989) 386-2020 | 334 N Ross, Beaverton, MI 48612 Ph: (989) 435-2020 |