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General NPI Number Information
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NPI Number | 1467475723
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Entity Type | Organization
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Legal Business Name | KALAMAZOO OPHTHALMOLOGY PC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 3412 W CENTRE AVE
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City | PORTAGE
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State | MI
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Zip | 49024-4624
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Country | US
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Telephone | 269-329-5860
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Fax | 269-329-5865
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Provider Business Mailing Address
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Address Line | 3412 W CENTRE AVE
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City | PORTAGE
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State | MI
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Zip | 49024-4624
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Country | US
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Telephone | 269-329-5860
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Fax | 269-329-5865
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN E HIGGINS
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Credential | M.D.
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Telephone | 269-329-5860
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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 |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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