Healthcare Provider Details

I. General information

NPI: 1326849837
Provider Name (Legal Business Name): LOGAN OOSTDYK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12606 HOLLY RD
GRAND BLANC MI
48439-1892
US

IV. Provider business mailing address

1227 HUNTERS RUN DR
GRAND BLANC MI
48439-6318
US

V. Phone/Fax

Practice location:
  • Phone: 810-694-3652
  • Fax: 810-694-0963
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005926
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007409
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: