=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396832937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THORNAPPLE OPHTHALMOLOGY ASSOC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 04/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 915 W GREEN ST SUITE 101
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49058-1724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-945-3866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 W GREEN ST SUITE 101
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49058-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-945-3866
-----------------------------------------------------
Fax | 269-945-9388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | MR. STEVEN M FLOHR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 616-897-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4901004379
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4901004439
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 4301047122
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------