1558401893 NPI number — SCHMITZER EYECARE, P.C.

Table of content: (NPI 1558401893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558401893 NPI number — SCHMITZER EYECARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHMITZER EYECARE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558401893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11973 SWEETWATER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND LEDGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48837-9196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-622-2020
Provider Business Mailing Address Fax Number:
517-627-4397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11973 SWEETWATER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND LEDGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48837-9196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-622-2020
Provider Business Practice Location Address Fax Number:
517-627-4397
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMITZER
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
OPTOMETRIST, PRESIDENT
Authorized Official Telephone Number:
517-622-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2766634 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4986361 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 900B311150 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 900B311320 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000007557 . This is a "PHP OF MID MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7323885 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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