Healthcare Provider Details

I. General information

NPI: 1508059627
Provider Name (Legal Business Name): EYE CARE WEST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26289 W CHICAGO RD
STURGIS MI
49091-8706
US

IV. Provider business mailing address

26289 W CHICAGO RD P O BOX 128
STURGIS MI
49091-8706
US

V. Phone/Fax

Practice location:
  • Phone: 269-651-7874
  • Fax: 269-651-4154
Mailing address:
  • Phone: 269-651-7874
  • Fax: 269-651-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002336
License Number StateMI

VIII. Authorized Official

Name: DR. DARREN L MEYER
Title or Position: PRESIDENT/OWNER
Credential: O.D.
Phone: 269-651-7874