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General NPI Number Information
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NPI Number | 1225278880
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Entity Type | Organization
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Legal Business Name | PEDIATRIC OPHTHALMOLOGY PC
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 5050 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3707
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Country | US
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Telephone | 616-957-0866
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Fax | 616-957-4102
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Provider Business Mailing Address
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Address Line | 5050 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3707
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Country | US
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Telephone | 616-957-0866
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Fax | 616-957-4102
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DEBORAH M DROSTE
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Credential | RN BSN
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Telephone | 616-957-0866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 003979
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License Number State | MI
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