Healthcare Provider Details

I. General information

NPI: 1891870903
Provider Name (Legal Business Name): FREEWILL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARIS AVE SE SUITE 112
GRAND RAPIDS MI
49546-3691
US

IV. Provider business mailing address

105 W EXCHANGE ST
SPRING LAKE MI
49456-2024
US

V. Phone/Fax

Practice location:
  • Phone: 616-956-9742
  • Fax: 616-956-9743
Mailing address:
  • Phone: 616-846-0620
  • Fax: 616-844-6079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY D WESTRA
Title or Position: PRESIDENT
Credential:
Phone: 616-846-0620