Provider Demographics
NPI:1215024450
Name:PERSONALEYES VISION CARE LLC
Entity Type:Organization
Organization Name:PERSONALEYES VISION CARE LLC
Other - Org Name:JAMES R SPEARS OD LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-364-8484
Mailing Address - Street 1:2860 E BELTLINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9704
Mailing Address - Country:US
Mailing Address - Phone:616-364-8484
Mailing Address - Fax:616-364-9686
Practice Address - Street 1:2860 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9704
Practice Address - Country:US
Practice Address - Phone:616-364-8484
Practice Address - Fax:616-364-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI94-5089046Medicaid
MI0351070001Medicare NSC
MIT33051Medicare UPIN
MI94-5089046Medicaid