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General NPI Number Information
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NPI Number | 1326318734
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Entity Type | Organization
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Legal Business Name | FRUITPORT FAMILY EYE CARE, PLLC
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 388 N 3RD AVE STE I
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City | FRUITPORT
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State | MI
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Zip | 49415-9785
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Country | US
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Telephone | 231-865-9990
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Fax | 231-865-9991
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Provider Business Mailing Address
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Address Line | 388 N 3RD AVE STE I
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City | FRUITPORT
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State | MI
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Zip | 49415-9785
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Country | US
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Telephone | 231-865-9990
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Fax | 231-865-9991
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Authorized Official
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Title or Position | SINGLE OWNER
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Name | DR. DEBORAH LYNN OSBORNE
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Credential | O.D.
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Telephone | 231-865-9990
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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 | 4901003947
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License Number State | MI
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