MEDICARE: VISION MAX PC

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	2958	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
2	0B41116	OTHER	MI	BLUECROSS
3	U31661	OTHER	MI	UPIN
4	0P50250	OTHER	MI	WPS

General Provider Information

NPI Number	:	1790978831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION MAX PC

Provider Business Mailing Address
First Line	:	1323 SPRING ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8720
Country	:	US
Telephone Number	:	231-439-3937
Fax Number	:	231-439-9058

Provider Business Practice Location Address
First Line	:	1323 SPRING ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8720
Country	:	US
Telephone Number	:	231-439-3937
Fax Number	:	231-439-9058

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MAX H. ENGELMAN
Credential	:	OD
Telephone Number	:	231-439-3937

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	03/16/2010

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Directions to “VISION MAX PC ” Practice Location

Language	Start Address	Practice Location

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