=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619165800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST SHORE EYE CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2007
-----------------------------------------------------
Last Update Date | 10/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 W LUDINGTON AVE
-----------------------------------------------------
City | LUDINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49431-2377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-843-4117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 W LUDINGTON AVE
-----------------------------------------------------
City | LUDINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49431-2377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-843-4117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JENNIFER L BRANNING
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 231-843-4117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------