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General NPI Number Information
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NPI Number | 1124205547
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Entity Type | Organization
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Legal Business Name | SOUTH KENT VISION CENTER PC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 4467 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-4808
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Country | US
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Telephone | 616-534-4953
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Fax |
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Provider Business Mailing Address
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Address Line | 4467 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-4808
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Country | US
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Telephone | 616-534-4953
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. ROBERT ARTHUR HOHENDORF
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Credential | O.D.
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Telephone | 616-534-4953
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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 | 4901002522
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License Number State | MI
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