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General NPI Number Information
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NPI Number | 1639234875
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Entity Type | Organization
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Legal Business Name | SOUTHWEST MICHIGAN EYE CENTER PLC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 3600 CAPITAL AVE SW STE 203
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City | BATTLE CREEK
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State | MI
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Zip | 49015-9393
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Country | US
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Telephone | 269-979-6383
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Fax | 269-979-6381
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Provider Business Mailing Address
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Address Line | 3600 CAPITAL AVE SW STE 203
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City | BATTLE CREEK
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State | MI
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Zip | 49015-9393
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Country | US
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Telephone | 269-979-6383
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Fax | 269-979-6381
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | DR. LARRY MARVIN VANDERPLAS
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Credential | MD
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Telephone | 269-979-6383
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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 | WW4820767
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License Number State | MI
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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 | RS048655
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | LV045322
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | PC052043
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License Number State | MI
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