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General NPI Number Information
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NPI Number | 1184283285
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Entity Type | Individual
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Provider Name | CARRIE DEWOLFE O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 9028 N RODGERS CT SE STE K
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City | CALEDONIA
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State | MI
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Zip | 49316-7786
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Country | US
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Telephone | 168-916-9245
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Fax | 616-891-4321
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Provider Business Mailing Address
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Address Line | 833 MICHIGAN ST NE STE 101
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2578
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Country | US
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Telephone | 989-245-8038
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4901005247
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License Number State | MI
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