| |
18301 Us Highway 12, New Buffalo, MI 49117-8848 | |
(269) 469-6331 | |
(269) 469-6848 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 18301 Us Highway 12, New Buffalo, Michigan |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1215089230 | NPI | - | NPPES |
900A10020 | Other | MI | BCBS GROUP PIN |
0P18480 | Other | MI | PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 04901003315 (Michigan) | Primary |
Mailing Address | Practice Location Address |
---|---|
18301 Us Highway 12, New Buffalo, MI 49117-8848 Ph: (269) 469-6331 | 18301 Us Highway 12, New Buffalo, MI 49117-8848 Ph: (269) 469-6331 |