Healthcare Provider Details

I. General information

NPI: 1659083020
Provider Name (Legal Business Name): NOONPLACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 BRETON RD SE
GRAND RAPIDS MI
49512-1745
US

IV. Provider business mailing address

5964 BROOKFARM DR SE
GRAND RAPIDS MI
49508-6568
US

V. Phone/Fax

Practice location:
  • Phone: 616-956-6096
  • Fax:
Mailing address:
  • Phone: 616-745-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: HAERI JANG
Title or Position: CEO
Credential:
Phone: 616-745-6454