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6290 Jupiter Ave Ne Ste A, Belmont, MI 49306-8885 | |
(616) 228-4790 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 6290 Jupiter Ave Ne Ste A, Belmont, Michigan |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1508248071 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | 4901004360 (Michigan) | Primary |
Provider Name | Mandy R Russell |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1316084965 PECOS PAC ID: 8426239385 Enrollment ID: I20110224000847 |
Mailing Address | Practice Location Address |
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6290 Jupiter Ave Ne Ste A, Belmont, MI 49306-8885 Ph: (616) 228-4790 | 6290 Jupiter Ave Ne Ste A, Belmont, MI 49306-8885 Ph: (616) 228-4790 |