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General NPI Number Information
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NPI Number | 1013100155
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Entity Type | Organization
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Legal Business Name | THORNAPPLE OPHTHALMOLGY THORNAPPLE OPHTHALMOLGY ASSOC PC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 423 W MAIN ST
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City | IONIA
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State | MI
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Zip | 48846-1553
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Country | US
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Telephone | 616-522-1000
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Fax | 616-527-3641
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Provider Business Mailing Address
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Address Line | 423 W MAIN ST
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City | IONIA
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State | MI
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Zip | 48846-1553
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Country | US
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Telephone | 616-522-1000
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Fax | 616-527-3641
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. STEVEN M FLOHR
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Credential |
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Telephone | 616-522-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004379
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004439
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MF047122
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License Number State | MI
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