Provider Demographics
NPI:1083926984
Name:JANSMA FAMILY EYE CARE INC
Entity Type:Organization
Organization Name:JANSMA FAMILY EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:H
Authorized Official - Last Name:JANSMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-261-3939
Mailing Address - Street 1:5491 DIVISION AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-5720
Mailing Address - Country:US
Mailing Address - Phone:616-261-3939
Mailing Address - Fax:616-261-3940
Practice Address - Street 1:5491 DIVISION AVE S
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-5720
Practice Address - Country:US
Practice Address - Phone:616-261-3939
Practice Address - Fax:616-261-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D16699OtherBLUE CROSS BLUE SHIELD OF MI
MI900D16699OtherBLUE CROSS BLUE SHIELD OF MI
MIU377704Medicare UPIN
MI1306020002Medicare NSC