=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265481683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZEELAND VISION SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2006
-----------------------------------------------------
Last Update Date | 05/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 S STATE ST SUITE #15
-----------------------------------------------------
City | ZEELAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49464-1678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-772-9149
-----------------------------------------------------
Fax | 616-772-2906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 S STATE ST SUITE #15
-----------------------------------------------------
City | ZEELAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49464-1678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-772-9149
-----------------------------------------------------
Fax | 616-772-2906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. THOMAS BOCK
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 616-772-9149
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------