Healthcare Provider Details

I. General information

NPI: 1104735562
Provider Name (Legal Business Name): STILL WATERS VISION REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 AIRLINE RD
MUSKEGON MI
49444-4556
US

IV. Provider business mailing address

4755 AIRLINE RD
MUSKEGON MI
49444-4556
US

V. Phone/Fax

Practice location:
  • Phone: 231-216-0123
  • Fax: 231-227-8811
Mailing address:
  • Phone: 231-216-0123
  • Fax: 231-227-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. LEAH JIPPING
Title or Position: MEMBER
Credential: OD
Phone: 231-557-7567