Healthcare Provider Details

I. General information

NPI: 1609792852
Provider Name (Legal Business Name): LANDON FETZER OD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4164 E BLUE GRASS RD
MOUNT PLEASANT MI
48858-7967
US

IV. Provider business mailing address

7515 RYANS RUN
STANWOOD MI
49346-8833
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-9481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005964
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: