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General NPI Number Information
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NPI Number | 1417179862
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Entity Type | Organization
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Legal Business Name | ABP EYESITE PC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 1230 E.BROOMFIELD SUITE 6
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City | MT.PLEASANT
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State | MI
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Zip | 48858
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Country | US
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Telephone | 989-773-2020
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Fax | 989-772-7757
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Provider Business Mailing Address
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Address Line | 1230 E.BROOMFIELD SUITE 6
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City | MT.PLEASANT
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State | MI
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Zip | 48858
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Country | US
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Telephone | 989-773-2020
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Fax | 989-772-7757
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Authorized Official
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Title or Position | ACCOUNTS REC.
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Name | MRS. DEANN D LITTLE
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Credential |
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Telephone | 989-773-2020
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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 |
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License Number State | MI
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