Healthcare Provider Details

I. General information

NPI: 1740299940
Provider Name (Legal Business Name): RANDALL J RIEMER, OD, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E BRIDGE ST
PORTLAND MI
48875-1436
US

IV. Provider business mailing address

207 E BRIDGE ST
PORTLAND MI
48875-1436
US

V. Phone/Fax

Practice location:
  • Phone: 517-647-2020
  • Fax: 517-647-7677
Mailing address:
  • Phone: 517-647-2020
  • Fax: 517-647-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002984
License Number StateMI

VIII. Authorized Official

Name: DR. RANDALL JOHN RIEMER
Title or Position: OWNER
Credential: O.D.
Phone: 517-647-2020