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General NPI Number Information
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NPI Number | 1821126384
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Entity Type | Organization
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Legal Business Name | NILES VISION CLINIC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 9 S SAINT JOSEPH AVE
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City | NILES
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State | MI
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Zip | 49120-2846
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Country | US
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Telephone | 269-683-4040
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Fax | 269-683-7565
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Provider Business Mailing Address
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Address Line | 9 S SAINT JOSEPH AVE
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City | NILES
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State | MI
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Zip | 49120-2846
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Country | US
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Telephone | 269-683-4040
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Fax | 269-683-7565
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. JEFFREY JOEL BECRAFT
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Credential | OPTOMETRIST
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Telephone | 269-683-4040
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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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