MEDICARE: MICHAEL T VOLLINK 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	4901003346	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629054127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T VOLLINK OD

Provider Business Mailing Address
First Line	:	3164 PORT SHELDON ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9317
Country	:	US
Telephone Number	:	616-538-0150
Fax Number	:	616-669-8457

Provider Business Practice Location Address
First Line	:	3164 PORT SHELDON ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9317
Country	:	US
Telephone Number	:	616-538-0150
Fax Number	:	616-669-1890

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	09/22/2021

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