Healthcare Provider Details

I. General information

NPI: 1841816220
Provider Name (Legal Business Name): EMILY ELIZABETH VLIETSTRA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 10 MILE RD NE
ROCKFORD MI
49341-9146
US

IV. Provider business mailing address

2745 10 MILE RD NE
ROCKFORD MI
49341-9146
US

V. Phone/Fax

Practice location:
  • Phone: 616-951-7115
  • Fax: 616-951-7112
Mailing address:
  • Phone: 616-951-7115
  • Fax: 616-951-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005476
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: