MEDICARE: DR. BRIAN JAMES HOUSER O.D.

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	4901004011	MI

General Provider Information

NPI Number	:	1467449793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN JAMES HOUSER O.D.

Provider Business Mailing Address
First Line	:	1995 CEDAR ST
Second Line	:	STE. 1
City	:	HOLT
State	:	MI
Zip	:	48842-6630
Country	:	US
Telephone Number	:	517-699-3937
Fax Number	:	517-699-4199

Provider Business Practice Location Address
First Line	:	1995 CEDAR ST
Second Line	:	STE. 1
City	:	HOLT
State	:	MI
Zip	:	48842-6630
Country	:	US
Telephone Number	:	517-699-3937
Fax Number	:	517-699-4199

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	07/08/2007

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