Provider Demographics
NPI:1164425666
Name:VISSER-ROBEL, KARI MARTHA (OD)
Entity Type:Individual
Prefix:DR
First Name:KARI
Middle Name:MARTHA
Last Name:VISSER-ROBEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49734-5220
Mailing Address - Country:US
Mailing Address - Phone:989-705-1255
Mailing Address - Fax:989-705-1476
Practice Address - Street 1:713 S WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1766
Practice Address - Country:US
Practice Address - Phone:989-705-1255
Practice Address - Fax:989-705-1476
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5780140001Medicare NSC
MIU58039Medicare UPIN
MI0N10120Medicare ID - Type Unspecified