Healthcare Provider Details

I. General information

NPI: 1609959089
Provider Name (Legal Business Name): ECENBARGER EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5751 BYRON CENTER AVE SW SUITE V
WYOMING MI
49519-9621
US

IV. Provider business mailing address

5751 BYRON CENTER AVE SW SUITE V
WYOMING MI
49519-9621
US

V. Phone/Fax

Practice location:
  • Phone: 616-532-2020
  • Fax: 616-532-2022
Mailing address:
  • Phone: 616-532-2020
  • Fax: 616-532-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCURRENTLY APPLYING
License Number StateMI

VIII. Authorized Official

Name: DR. SCOTT RICHARD ECENBARGER
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 616-532-2020