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General NPI Number Information
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NPI Number | 1639459019
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Entity Type | Individual
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Provider Name | JORDAN KUIPERS O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 11/09/2016
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Provider Practice Location Address
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Address Line | 5838 METRO WAY
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City | WYOMING
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State | MI
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Zip | 49519
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Country | US
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Telephone | 616-249-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 5838 METRO WAY
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City | WYOMING
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State | MI
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Zip | 49519
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Country | US
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Telephone | 616-249-5300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4901004648
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License Number State | MI
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