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NPI Code Detail

MEDICARE: NORTHSIDE OPTOMETRIC PRACTICE P C

MEDICARE: NORTHSIDE OPTOMETRIC PRACTICE P C
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
1152W00000XOptometristL951178MI

General Provider Information

NPI Number : 1265655120
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHSIDE OPTOMETRIC PRACTICE P C
Provider Business Mailing Address
First Line : 100 NORTH AVE
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49017-3417
Country : US
Telephone Number : 269-288-8400
Fax Number : 269-963-9202
Provider Business Practice Location Address
First Line : 100 NORTH AVE
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49017-3417
Country : US
Telephone Number : 269-288-8400
Fax Number : 269-963-9202
Authorized Official
Title or Position : OWNER
Name : DR. GREGORY DUANE DOTSON
Credential : O.D.
Telephone Number : 269-288-8400
Provider Enumeration Date : 04/10/2007
Last Update Date : 08/22/2020

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Directions to “NORTHSIDE OPTOMETRIC PRACTICE P C ” Practice Location

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