Provider Demographics
NPI:1144427949
Name:COMPREHENSIVE EYE CARE PC
Entity Type:Organization
Organization Name:COMPREHENSIVE EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-361-6612
Mailing Address - Street 1:2700 5 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 5 MILE RD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1710
Practice Address - Country:US
Practice Address - Phone:616-361-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4901003334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4259720001OtherADMINISTAR FED B DME MAC
MIMI 4010OtherOTHER
MI900D166330OtherBCBSM
MIU24285Medicare UPIN