Healthcare Provider Details

I. General information

NPI: 1346546637
Provider Name (Legal Business Name): HESPERIA EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 N DIVISION ST
HESPERIA MI
49421-5100
US

IV. Provider business mailing address

38 N DIVISION ST
HESPERIA MI
49421-5100
US

V. Phone/Fax

Practice location:
  • Phone: 231-854-3000
  • Fax: 231-854-3000
Mailing address:
  • Phone: 231-854-3000
  • Fax: 231-854-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DOUGLAS LEON TOTTEN
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 231-557-3753