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General NPI Number Information
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NPI Number | 1346963758
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Entity Type | Organization
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Legal Business Name | WEST MICHIGAN CONTACT LENS SPECIALISTS PLLC
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 4130 BRETON RD SE STE A
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City | KENTWOOD
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State | MI
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Zip | 49512-3808
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Country | US
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Telephone | 616-341-1713
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Fax |
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Provider Business Mailing Address
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Address Line | 7719 DREAM ISLE DR NE
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City | BELDING
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State | MI
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Zip | 48809-9370
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Country | US
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Telephone | 989-906-7786
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Fax |
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | DR. ADELINE R BAUER
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Credential | OD
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Telephone | 989-906-7786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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