Healthcare Provider Details

I. General information

NPI: 1447411228
Provider Name (Legal Business Name): PINNACLE EYECARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 W LAKE LANSING RD STE 115
EAST LANSING MI
48823-8525
US

IV. Provider business mailing address

139 W LAKE LANSING RD STE 115
EAST LANSING MI
48823-8525
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-1832
  • Fax: 517-337-1854
Mailing address:
  • Phone: 517-337-1832
  • Fax: 517-337-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004013
License Number StateMI

VIII. Authorized Official

Name: KEVIN JACOBS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 517-337-1832