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General NPI Number Information
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NPI Number | 1922206531
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Entity Type | Organization
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Legal Business Name | WYOMING FAMILY VISION CARE PLLC
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 1391 36TH ST SW
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City | WYOMING
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State | MI
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Zip | 49509-3417
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Country | US
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Telephone | 616-538-5420
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Fax | 616-538-7288
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Provider Business Mailing Address
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Address Line | 1391 36TH ST SW
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City | WYOMING
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State | MI
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Zip | 49509-3417
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Country | US
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Telephone | 616-538-5420
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Fax | 616-538-7288
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD J CHORYAN
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Credential | O.D.
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Telephone | 616-538-5420
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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 | 4901002687
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License Number State | MI
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