Provider Demographics
NPI:1093737652
Name:GIASEMAN, DEB
Entity Type:Individual
Prefix:
First Name:DEB
Middle Name:
Last Name:GIASEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 JORDAN LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ODESSA
Mailing Address - State:MI
Mailing Address - Zip Code:48849-1212
Mailing Address - Country:US
Mailing Address - Phone:616-374-3284
Mailing Address - Fax:616-374-2020
Practice Address - Street 1:1170 JORDAN LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849-1212
Practice Address - Country:US
Practice Address - Phone:616-374-3284
Practice Address - Fax:616-374-2020
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI164718OtherABOC