Provider Demographics
NPI:1336325414
Name:POPOWITZ, GREGORY (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:POPOWITZ
Suffix:
Gender:M
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 208177
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-1918
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:517-886-0224
Practice Address - Street 1:5403 W SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1918
Practice Address - Country:US
Practice Address - Phone:517-886-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000002542Medicaid
MI253368Medicaid
MI200000002541Medicaid
MI0C36852OtherBCBS OF MI
MI203456Medicaid
MI253368Medicaid
MI200000002542Medicaid
MI0C36852OtherBCBS OF MI