MEDICARE: MR. MARC M PRIEUR 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	4901003646	MI

General Provider Information

NPI Number	:	1487672937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARC M PRIEUR OD

Provider Business Mailing Address
First Line	:	1825 S PARK ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49001-2762
Country	:	US
Telephone Number	:	269-342-0003
Fax Number	:	269-342-4284

Provider Business Practice Location Address
First Line	:	755 E CHICAGO
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-2027
Country	:	US
Telephone Number	:	517-278-9004
Fax Number	:	269-342-4284

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	05/10/2021

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