Healthcare Provider Details

I. General information

NPI: 1871510859
Provider Name (Legal Business Name): FERRIS STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 S STATE 101 H
BIG RAPIDS MI
49307
US

IV. Provider business mailing address

1124 S STATE 101 H.
BIG RAPIDS MI
49307
US

V. Phone/Fax

Practice location:
  • Phone: 231-591-2020
  • Fax: 231-591-3991
Mailing address:
  • Phone: 231-591-2020
  • Fax: 231-591-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. JENNIFER M OSOSKI
Title or Position: MEDICAL RECORDS/INSURANCE SPECIALIS
Credential: RHIA
Phone: 231-591-3056