MEDICARE: GEORGE WILLIAM MCNIVEN 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	002288	MI

General Provider Information

NPI Number	:	1629064316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE WILLIAM MCNIVEN OD

Provider Business Mailing Address
First Line	:	269 N CHURCH RD
Second Line	:
City	:	CARSONVILLE
State	:	MI
Zip	:	48419-9197
Country	:	US
Telephone Number	:	810-657-9521
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 W SANILAC RD
Second Line	:	BOX 112
City	:	SANDUSKY
State	:	MI
Zip	:	48471-1036
Country	:	US
Telephone Number	:	810-648-4242
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	11/14/2007

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