Provider Demographics
NPI:1023005279
Name:KWAPIS, YVONNE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:MARIE
Last Name:KWAPIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10344 THOR DR STE B
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-8430
Mailing Address - Country:US
Mailing Address - Phone:989-692-2020
Mailing Address - Fax:989-692-2021
Practice Address - Street 1:10344 THOR DR STE B
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-8430
Practice Address - Country:US
Practice Address - Phone:989-692-2020
Practice Address - Fax:989-692-2021
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003682152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIKW0712651OtherOLD PIN NUMBER
MIKW0712651OtherOLD PIN NUMBER