Provider Demographics
NPI:1215605134
Name:CARLSON EYE CARE, LLC
Entity Type:Organization
Organization Name:CARLSON EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-459-7380
Mailing Address - Street 1:55 CAMPAU AVE NW
Mailing Address - Street 2:SUITE 10
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2642
Mailing Address - Country:US
Mailing Address - Phone:616-459-7380
Mailing Address - Fax:616-459-5752
Practice Address - Street 1:55 CAMPAU AVE NW
Practice Address - Street 2:SUITE 10
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2642
Practice Address - Country:US
Practice Address - Phone:616-459-7380
Practice Address - Fax:616-459-5752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty