Healthcare Provider Details

I. General information

NPI: 1841521838
Provider Name (Legal Business Name): NILES VISION CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 S SAINT JOSEPH AVE
NILES MI
49120-2846
US

IV. Provider business mailing address

9 S SAINT JOSEPH AVE
NILES MI
49120-2846
US

V. Phone/Fax

Practice location:
  • Phone: 269-683-4040
  • Fax:
Mailing address:
  • Phone: 269-683-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JEFFREY JOEL BECRAFT
Title or Position: PRESIDENT
Credential: O.D.
Phone: 269-683-4040