Provider Demographics
NPI:1073964912
Name:GREATER THUMB EYECARE, PLC
Entity Type:Organization
Organization Name:GREATER THUMB EYECARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-635-1500
Mailing Address - Street 1:2575 S VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-9787
Mailing Address - Country:US
Mailing Address - Phone:989-635-1500
Mailing Address - Fax:989-635-3937
Practice Address - Street 1:2575 S VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-9787
Practice Address - Country:US
Practice Address - Phone:989-635-1500
Practice Address - Fax:989-635-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9548001Medicare Oscar/Certification
MIU87205Medicare UPIN