| |
334 N Ross St, Beaverton, MI 48612-8165 | |
(989) 435-2020 | |
(989) 435-2554 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 334 N Ross St, Beaverton, Michigan |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1356698534 | NPI | - | NPPES |
1356698534 | Medicaid | MI | |
0A80041 | Other | MI | BLUECROSS BLUESHIED |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 4901004640 (Michigan) | Primary |
Mailing Address | Practice Location Address |
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Po Box 505, Beaverton, MI 48612-0505 Ph: (989) 435-2020 | 334 N Ross St, Beaverton, MI 48612-8165 Ph: (989) 435-2020 |