MEDICARE: DR. DAVID GENE SEVENSMA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2473	MI

General Provider Information

NPI Number	:	1205990363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID GENE SEVENSMA OD

Provider Business Mailing Address
First Line	:	2730 FIVE MILE RD NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-6518
Country	:	US
Telephone Number	:	616-361-6601
Fax Number	:	616-361-6601

Provider Business Practice Location Address
First Line	:	2730 FIVE MILE RD NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-6518
Country	:	US
Telephone Number	:	616-361-6601
Fax Number	:	616-361-6601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	11/18/2008

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