MEDICARE: MOBILE VISION LLC

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	3336	MI

General Provider Information

NPI Number	:	1700200227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE VISION LLC

Provider Business Mailing Address
First Line	:	1737 SPRING ARBOR RD # 164
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-2701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1737 SPRING ARBOR RD # 164
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-2701
Country	:	US
Telephone Number	:	517-740-5814
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. BRICKER BUSETH
Credential	:
Telephone Number	:	517-740-5814

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	03/25/2014

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Directions to “MOBILE VISION LLC ” Practice Location

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