Healthcare Provider Details

I. General information

NPI: 1104176213
Provider Name (Legal Business Name): EXCEL INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 MUNSON AVE SUITE C
TRAVERSE CITY MI
49686
US

IV. Provider business mailing address

328 MUNSON AVE SUITE C
TRAVERSE CITY MI
49686-3040
US

V. Phone/Fax

Practice location:
  • Phone: 231-946-7700
  • Fax:
Mailing address:
  • Phone: 231-946-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. MARK D NOSS
Title or Position: MEMBER
Credential: O.D
Phone: 231-946-7700