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General NPI Number Information
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NPI Number | 1295922094
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Entity Type | Organization
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Legal Business Name | PRANGE FAMILY EYECARE, LLC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 2121 HUDSON AVE SUITE 105
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City | KALAMAZOO
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State | MI
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Zip | 49008-2379
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Country | US
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Telephone | 269-345-2916
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Fax | 269-345-5335
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Provider Business Mailing Address
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Address Line | 2121 HUDSON AVE SUITE 105
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City | KALAMAZOO
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State | MI
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Zip | 49008-2379
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Country | US
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Telephone | 269-345-2916
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Fax | 269-345-5335
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MS. THEA L TRAVIS
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Credential |
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Telephone | 269-372-0075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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