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General NPI Number Information
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NPI Number | 1760035869
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Entity Type | Organization
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Legal Business Name | BLUE COAST VISION PC
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 384 1ST ST
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City | MANISTEE
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State | MI
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Zip | 49660-1751
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Country | US
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Telephone | 231-590-4305
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Fax |
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Provider Business Mailing Address
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Address Line | 1289 IVANHOE RD
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City | LUDINGTON
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State | MI
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Zip | 49431-1119
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Country | US
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Telephone | 231-590-4305
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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 | PAMELA LYNCH
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Credential | OD
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Telephone | 231-590-4305
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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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