Healthcare Provider Details

I. General information

NPI: 1891846812
Provider Name (Legal Business Name): ASSOCIATES IN EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8470 MAIN ST
BIRCH RUN MI
48415-9704
US

IV. Provider business mailing address

8470 MAIN ST
BIRCH RUN MI
48415-9704
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 TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number4901004706
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4901003182
License Number StateMI

VIII. Authorized Official

Name: SUSAN M PERDUE
Title or Position: PHYSICAN
Credential: OD
Phone: 989-624-2020