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General NPI Number Information
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NPI Number | 1669133229
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Entity Type | Organization
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Legal Business Name | WOODBRIDGE FAMILY EYE CARE
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 4070 CHICAGO DR SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1258
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Country | US
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Telephone | 616-531-3336
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Fax |
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Provider Business Mailing Address
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Address Line | 4070 CHICAGO DR SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1258
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Country | US
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Telephone | 616-531-3336
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DANIELLE WOODBRIDGE
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Credential | OD
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Telephone | 989-860-2994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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