Healthcare Provider Details

I. General information

NPI: 1982009601
Provider Name (Legal Business Name): WESTSIDE EYE CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14915 W MICHIGAN AVE
MARSHALL MI
49068-8504
US

IV. Provider business mailing address

14915 W MICHIGAN AVE
MARSHALL MI
49068-8504
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-9863
  • Fax: 269-781-8964
Mailing address:
  • Phone: 269-781-9863
  • Fax: 269-781-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number05968U
License Number StateMI

VIII. Authorized Official

Name: DR. JEFFREY JAMES FITZMAURICE
Title or Position: OWNER
Credential: O.D.
Phone: 586-350-3141