| |
2200 Coolidge Rd, Ste #15, East Lansing, MI 48823-1363 | |
(517) 977-1598 | |
(517) 977-1785 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 2200 Coolidge Rd, East Lansing, Michigan |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1629423082 | NPI | - | NPPES |
1730237579 | Other | MI | NPI INDIVIDUAL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 4901003790 (Michigan) | Secondary |
332H00000X | Eyewear Supplier | 4901003790 (Michigan) | Primary |
Mailing Address | Practice Location Address |
---|---|
2200 Coolidge Rd, Ste #15, East Lansing, MI 48823-1363 Ph: (517) 977-1598 | 2200 Coolidge Rd, Ste #15, East Lansing, MI 48823-1363 Ph: (517) 977-1598 |