Healthcare Provider Details

I. General information

NPI: 1023005279
Provider Name (Legal Business Name): YVONNE MARIE KWAPIS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10344 THOR DR STE B
FREELAND MI
48623-8430
US

IV. Provider business mailing address

10344 THOR DR STE B
FREELAND MI
48623-8430
US

V. Phone/Fax

Practice location:
  • Phone: 989-692-2020
  • Fax: 989-692-2021
Mailing address:
  • Phone: 989-692-2020
  • Fax: 989-692-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003682
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: