Provider Demographics
NPI:1013040120
Name:THREE RIVERS EYECARE PC
Entity Type:Organization
Organization Name:THREE RIVERS EYECARE PC
Other - Org Name:SUSSEX VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUSSEX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:269-964-9200
Mailing Address - Street 1:1525 A W MICHIGAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017
Mailing Address - Country:US
Mailing Address - Phone:269-964-9200
Mailing Address - Fax:269-964-8818
Practice Address - Street 1:1525 A W MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017
Practice Address - Country:US
Practice Address - Phone:269-964-9200
Practice Address - Fax:269-964-8818
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THREE RIVERS EYECARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944932600Medicaid
MI944946517Medicaid
900G510070OtherBCBS
MI1251300003Medicare NSC
900G510070OtherBCBS