Healthcare Provider Details

I. General information

NPI: 1356454466
Provider Name (Legal Business Name): VISION SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTH AVE
BATTLE CREEK MI
49017-3417
US

IV. Provider business mailing address

105 W EXCHANGE ST
SPRING LAKE MI
49456-2024
US

V. Phone/Fax

Practice location:
  • Phone: 269-962-7595
  • Fax: 269-963-9202
Mailing address:
  • Phone: 616-846-0620
  • Fax: 616-844-6079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002642
License Number StateMI

VIII. Authorized Official

Name: JONATHAN WESTRA
Title or Position: CONTROLLER
Credential:
Phone: 616-846-0620