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General NPI Number Information
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NPI Number | 1013040120
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Entity Type | Organization
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Legal Business Name | THREE RIVERS EYECARE PC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1525 A W MICHIGAN AVENUE
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City | BATTLE CREEK
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State | MI
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Zip | 49017
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Country | US
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Telephone | 269-964-9200
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Fax | 269-964-8818
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Provider Business Mailing Address
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Address Line | 1525 A W MICHIGAN AVENUE
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City | BATTLE CREEK
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State | MI
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Zip | 49017
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Country | US
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Telephone | 269-964-9200
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Fax | 269-964-8818
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL L SUSSEX
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Credential | OD
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Telephone | 269-964-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | MI
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