| |
44 S State St, Hart, MI 49420-1123 | |
(231) 873-2575 | |
(231) 873-2593 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 44 S State St, Hart, Michigan |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1568655355 | NPI | - | NPPES |
2644375 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 4901003163 (Michigan) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | 4901003163 (Michigan) | Secondary |
Provider Name | Michael E Jonassen |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1922187673 PECOS PAC ID: 6608927314 Enrollment ID: I20090619000080 |
Mailing Address | Practice Location Address |
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44 S State St, Hart, MI 49420-1123 Ph: (231) 873-2575 | 44 S State St, Hart, MI 49420-1123 Ph: (231) 873-2575 |
Dr. Michael Edward Jonassen, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 44 S State St, Hart, MI 49420 Phone: 231-873-2575 Fax: 231-873-2593 |