Healthcare Provider Details

I. General information

NPI: 1063686343
Provider Name (Legal Business Name): RICHARD J NEUENFELDT ODPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12830 S SAGINAW ST SUITE C
GRAND BLANC MI
48439-2415
US

IV. Provider business mailing address

12830 S SAGINAW ST SUITE C
GRAND BLANC MI
48439-2415
US

V. Phone/Fax

Practice location:
  • Phone: 810-695-3500
  • Fax: 810-695-3502
Mailing address:
  • Phone: 810-695-3500
  • Fax: 810-695-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICHARD J NEUENFELDT
Title or Position: PRESIDENT
Credential: O.D.
Phone: 810-695-3500