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General NPI Number Information
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NPI Number | 1871761965
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Entity Type | Organization
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Legal Business Name | CAPITAL CITY VISION PC
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 1865 W GRAND RIVER AVE
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City | OKEMOS
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State | MI
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Zip | 48864-1840
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Country | US
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Telephone | 517-349-2393
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Fax | 517-349-3751
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Provider Business Mailing Address
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Address Line | 1865 W GRAND RIVER AVE
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City | OKEMOS
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State | MI
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Zip | 48864-1840
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Country | US
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Telephone | 517-349-2393
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Fax | 517-349-3751
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | MICHELLE WHITMAN
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Credential |
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Telephone | 517-349-2393
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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 | 4901003644
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License Number State | MI
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