Provider Demographics
NPI:1003997651
Name:JEFFREY B. BYLAND, O.D., P.C.
Entity Type:Organization
Organization Name:JEFFREY B. BYLAND, O.D., P.C.
Other - Org Name:EXCELLENCE IN VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EENIGENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-924-4110
Mailing Address - Street 1:103 S DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1602
Mailing Address - Country:US
Mailing Address - Phone:231-924-4110
Mailing Address - Fax:231-924-5007
Practice Address - Street 1:103 S DIVISION AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1602
Practice Address - Country:US
Practice Address - Phone:231-924-4110
Practice Address - Fax:231-924-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002849332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI410014405OtherMEDICARE RAILROAD
MI900F26506OtherBC BS OF MI
MI2892598Medicaid
MIT33321Medicare UPIN
MI2892598Medicaid
MI900F26506OtherBC BS OF MI
MI0220870001Medicare NSC