Dan Lee Fortenbacher, OD is a
Optometrist - Vision Therapy based in St Joseph, Michigan. Dan Lee Fortenbacher is licensed to practice in Michigan (license number 4901002693) and his current practice location is
2908 Division Street, St Joseph, Michigan. He can be reached at his office (for appointments etc.) via phone at
(269) 983-3309.
NPI number for Dan Lee Fortenbacher is 1760519946 and his current mailing address is 2908 Division Street, St Joseph, Michigan. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1760519946.
Healthcare Provider's Profile
| Full Name | Dan Lee Fortenbacher |
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| Gender | Male |
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| Speciality | Optometrist - Vision Therapy |
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| Location | 2908 Division Street, St Joseph, Michigan |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1760519946
- Provider Enumeration Date: 02/27/2007
- Last Update Date: 05/20/2015
Medical Identifiers
Medical identifiers for Dan Lee Fortenbacher such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1760519946 | NPI | - | NPPES |
| 900A165280 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | 4901002693 (Michigan) | Secondary |
| 152WV0400X | Optometrist - Vision Therapy | 4901002693 (Michigan) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dan Lee Fortenbacher is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dan Lee Fortenbacher, OD
2908 Division Street,
St Joseph, MI 49085
Ph: (269) 983-3309 | Dan Lee Fortenbacher, OD
2908 Division Street,
St Joseph, MI 49085
Ph: (269) 983-3309 |
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