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General NPI Number Information
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NPI Number | 1093979742
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Entity Type | Organization
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Legal Business Name | MARC L AUSTHOF OD EYE CARE SERVICES PLLC
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 2640 CROSSING CIR
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-7930
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Country | US
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Telephone | 231-933-7195
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Fax | 231-933-7197
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Provider Business Mailing Address
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Address Line | 2640 CROSSING CIR
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-7930
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Country | US
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Telephone | 231-933-7195
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Fax | 231-933-7197
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARC LOUIS AUSTHOF
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Credential | O.D.
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Telephone | 231-933-7195
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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 | 4901003842
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License Number State | MI
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