MEDICARE: DR. NATHAN NORMAN NEUENFELDT

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	4901005909	MI

General Provider Information

NPI Number	:	1689464471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN NORMAN NEUENFELDT

Provider Business Mailing Address
First Line	:	12770 S SAGINAW ST
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-1831
Country	:	US
Telephone Number	:	810-695-3500
Fax Number	:	810-695-3502

Provider Business Practice Location Address
First Line	:	12770 S SAGINAW ST
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-1831
Country	:	US
Telephone Number	:	810-695-3500
Fax Number	:

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

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	08/04/2025

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