Healthcare Provider Details

I. General information

NPI: 1073025516
Provider Name (Legal Business Name): EYE CARE PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8470 MAIN ST
BIRCH RUN MI
48415-9461
US

IV. Provider business mailing address

8470 MAIN ST
BIRCH RUN MI
48415-9461
US

V. Phone/Fax

Practice location:
  • Phone: 989-624-2020
  • Fax: 989-624-6257
Mailing address:
  • Phone: 989-624-2020
  • Fax: 989-624-6257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE JARUZEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 624-624-2020