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General NPI Number Information
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NPI Number | 1992227169
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Entity Type | Individual
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Provider Name | NEIL PHILIP RENAUD OD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 1121 OTTAWA BEACH RD STE 140
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City | HOLLAND
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State | MI
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Zip | 49424-2528
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Country | US
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Telephone | 616-848-7548
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Fax | 616-848-7558
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Provider Business Mailing Address
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Address Line | 1121 OTTAWA BEACH RD STE 140
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City | HOLLAND
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State | MI
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Zip | 49424-2528
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Country | US
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Telephone | 616-848-7548
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Fax | 616-848-7558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 4901005159
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License Number State | MI
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