Provider Demographics
NPI:1205827383
Name:VOREIS, PAUL KENT (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENT
Last Name:VOREIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:21947 CANTERBURY AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1308
Mailing Address - Country:US
Mailing Address - Phone:734-676-1444
Mailing Address - Fax:
Practice Address - Street 1:17901 HURON RIVER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW BOSTON
Practice Address - State:MI
Practice Address - Zip Code:48164-3200
Practice Address - Country:US
Practice Address - Phone:734-753-9360
Practice Address - Fax:734-753-9311
Is Sole Proprietor?:No
Enumeration Date:2005-10-29
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901002567152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4602632Medicaid
MIU26747Medicare UPIN
MIMI1363001Medicare PIN