Provider Demographics
NPI:1154454411
Name:GRAND RAPIDS EYE INSTITUTE, PLC
Entity Type:Organization
Organization Name:GRAND RAPIDS EYE INSTITUTE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-285-3700
Mailing Address - Street 1:1959 EAST PARIS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6272
Mailing Address - Country:US
Mailing Address - Phone:616-285-3700
Mailing Address - Fax:616-285-8151
Practice Address - Street 1:1959 EAST PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6272
Practice Address - Country:US
Practice Address - Phone:616-285-3700
Practice Address - Fax:616-285-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRP004201152W00000X
MIAD004260152W00000X
MIBB2701301207W00000X
MIDD014374207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP03650Medicare ID - Type Unspecified
MION25840Medicare ID - Type Unspecified