Healthcare Provider Details

I. General information

NPI: 1134404288
Provider Name (Legal Business Name): LAUREN E COLLINS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 01/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 ROMENCE RD. HIEMSTRA OPTICAL CO.
PORTAGE MI
49024
US

IV. Provider business mailing address

255 ROMENCE RD. HIEMSTRA OPTICAL CO.
PORTAGE MI
49024
US

V. Phone/Fax

Practice location:
  • Phone: 269-324-0800
  • Fax: 269-324-0894
Mailing address:
  • Phone: 269-324-0800
  • Fax: 269-324-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004853
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: