Healthcare Provider Details

I. General information

NPI: 1891778189
Provider Name (Legal Business Name): CUTLERVILLE EYECARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6680 S DIVISION AVE
GRAND RAPIDS MI
49548-7834
US

IV. Provider business mailing address

6680 S DIVISION AVE
GRAND RAPIDS MI
49548-7834
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-2525
  • Fax: 616-455-9135
Mailing address:
  • Phone: 616-455-2525
  • Fax: 616-455-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JACQUIE BEYER
Title or Position: BILLER
Credential:
Phone: 616-455-2525