MEDICARE: HUDSONVILLE VISION CARE INC

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

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972695617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSONVILLE VISION CARE INC

Provider Business Mailing Address
First Line	:	3232 CENTRAL BLVD
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-1439
Country	:	US
Telephone Number	:	616-669-2530
Fax Number	:	616-669-3646

Provider Business Practice Location Address
First Line	:	3232 CENTRAL BLVD
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-1439
Country	:	US
Telephone Number	:	616-669-2530
Fax Number	:	616-669-3646

Authorized Official
Title or Position	:	CO-OWNER
Name	:	STACEY KAY WUSTMAN
Credential	:	DO
Telephone Number	:	616-669-2530

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	06/24/2024

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