Healthcare Provider Details

I. General information

NPI: 1619089935
Provider Name (Legal Business Name): DEANA R PLATZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LINDEN ST SUITE 5
BIG RAPIDS MI
49307-1880
US

IV. Provider business mailing address

650 LINDEN ST SUITE 5
BIG RAPIDS MI
49307-1880
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-0010
  • Fax: 231-796-2496
Mailing address:
  • Phone: 231-796-0010
  • Fax: 231-796-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003941
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: