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General NPI Number Information
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NPI Number | 1962115238
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Entity Type | Organization
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Legal Business Name | DR. CARRIE DEWOLFE OD PLC
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 9028 N RODGERS CT SE STE K
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City | CALEDONIA
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State | MI
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Zip | 49316-7786
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Country | US
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Telephone | 989-245-8038
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Fax |
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Provider Business Mailing Address
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Address Line | 843 CRESCENT ST NE APT 1
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3503
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Country | US
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Telephone | 989-245-8038
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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 | DR. CARRIE MARIE DEWOLFE
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Credential | OD
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Telephone | 616-891-9245
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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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