Healthcare Provider Details

I. General information

NPI: 1487614012
Provider Name (Legal Business Name): AILEEN N BROUWER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W US HIGHWAY 2
NORWAY MI
49870-1127
US

IV. Provider business mailing address

525 W US HIGHWAY 2
NORWAY MI
49870-1127
US

V. Phone/Fax

Practice location:
  • Phone: 906-563-5711
  • Fax: 906-563-9196
Mailing address:
  • Phone: 906-563-5711
  • Fax: 906-563-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002618
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: