Provider Demographics
NPI:1063686343
Name:RICHARD J NEUENFELDT ODPC
Entity Type:Organization
Organization Name:RICHARD J NEUENFELDT ODPC
Other - Org Name:NEUENFELDT FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEUENFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-695-3500
Mailing Address - Street 1:12830 S SAGINAW ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2415
Mailing Address - Country:US
Mailing Address - Phone:810-695-3500
Mailing Address - Fax:810-695-3502
Practice Address - Street 1:12830 S SAGINAW ST
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2415
Practice Address - Country:US
Practice Address - Phone:810-695-3500
Practice Address - Fax:810-695-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900B565970OtherBCBS
MI0996169OtherHEALTH PLUS
MI0996169OtherHEALTH PLUS
MIU53097Medicare UPIN