Provider Demographics
NPI:1346963758
Name:WEST MICHIGAN CONTACT LENS SPECIALISTS PLLC
Entity Type:Organization
Organization Name:WEST MICHIGAN CONTACT LENS SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-906-7786
Mailing Address - Street 1:7719 DREAM ISLE DR NE
Mailing Address - Street 2:
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-9370
Mailing Address - Country:US
Mailing Address - Phone:989-906-7786
Mailing Address - Fax:
Practice Address - Street 1:4130 BRETON RD SE STE A
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-3808
Practice Address - Country:US
Practice Address - Phone:616-341-1713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901004841OtherOPTOMETRY LICENSE NUMBER