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General NPI Number Information
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NPI Number | 1417148669
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Entity Type | Organization
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Legal Business Name | KALAMAZOO OPTOMETRY PC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 5949 LOVERS LN
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City | PORTAGE
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State | MI
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Zip | 49002-1680
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Country | US
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Telephone | 269-382-6500
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Fax | 269-382-2286
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Provider Business Mailing Address
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Address Line | 5949 LOVERS LN
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City | PORTAGE
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State | MI
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Zip | 49002-1680
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Country | US
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Telephone | 269-382-6500
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Fax | 269-382-2286
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. STACY HIEMSTRA
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Credential |
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Telephone | 269-382-6500
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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 | 4901002440
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License Number State | MI
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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 | 4901004197
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901002352
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901002237
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License Number State | MI
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