Healthcare Provider Details

I. General information

NPI: 1538940010
Provider Name (Legal Business Name): MATTAWAN FAMILY EYE CARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52883 N MAIN ST
MATTAWAN MI
49071-8309
US

IV. Provider business mailing address

52883 N MAIN ST
MATTAWAN MI
49071-8309
US

V. Phone/Fax

Practice location:
  • Phone: 269-668-5558
  • Fax:
Mailing address:
  • Phone: 269-668-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TERESA SEIM
Title or Position: OWNER
Credential: OD
Phone: 269-668-5558