Healthcare Provider Details

I. General information

NPI: 1154454411
Provider Name (Legal Business Name): GRAND RAPIDS EYE INSTITUTE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 EAST PARIS AVE SE
GRAND RAPIDS MI
49546-6272
US

IV. Provider business mailing address

1959 EAST PARIS AVE SE
GRAND RAPIDS MI
49546-6272
US

V. Phone/Fax

Practice location:
  • Phone: 616-285-3700
  • Fax: 616-285-8151
Mailing address:
  • Phone: 616-285-3700
  • Fax: 616-285-8151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberRP004201
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberAD004260
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberBB2701301
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDD014374
License Number StateMI

VIII. Authorized Official

Name: MRS. CHRIS WHEATON
Title or Position: BILLING SPECIALIST
Credential:
Phone: 616-285-3700