Healthcare Provider Details

I. General information

NPI: 1619742178
Provider Name (Legal Business Name): COMPREHENSIVE EYE CARE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 5 MILE RD NE STE 102
GRAND RAPIDS MI
49525-6516
US

IV. Provider business mailing address

2700 5 MILE RD NE STE 102
GRAND RAPIDS MI
49525-6516
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-6612
  • Fax:
Mailing address:
  • Phone: 616-361-6612
  • Fax: 616-361-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. FELICIA SLATE
Title or Position: OWNER
Credential: OD
Phone: 231-742-2541