Healthcare Provider Details

I. General information

NPI: 1487621686
Provider Name (Legal Business Name): DR. WM J GRAS PHD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 TAFT ST
ZEELAND MI
49464-1625
US

IV. Provider business mailing address

220 TAFT ST
ZEELAND MI
49464-1625
US

V. Phone/Fax

Practice location:
  • Phone: 616-772-2375
  • Fax: 616-772-2375
Mailing address:
  • Phone: 616-772-2375
  • Fax: 616-772-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number4301038103
License Number StateMI

VIII. Authorized Official

Name: DR. WILLIAM JOHN GRAS
Title or Position: EYE SURGEON
Credential: M.D.
Phone: 616-772-2375