Healthcare Provider Details

I. General information

NPI: 1639493588
Provider Name (Legal Business Name): RAPIDS OPHTHALMOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 W SHAW ST
HOWARD CITY MI
49329-9401
US

IV. Provider business mailing address

650 LINDEN ST STE 5
BIG RAPIDS MI
49307-1879
US

V. Phone/Fax

Practice location:
  • Phone: 231-937-8206
  • Fax: 231-937-9060
Mailing address:
  • Phone: 231-796-0010
  • Fax: 231-796-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberDP003941
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberRC008359
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberBC042824
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberJB013778
License Number StateMI

VIII. Authorized Official

Name: JULIE BOSS
Title or Position: VICE PRESIDENT
Credential: D.O.
Phone: 231-796-0010