Provider Demographics
NPI:1366509002
Name:DAVID SZCZEPANSKI PC
Entity Type:Organization
Organization Name:DAVID SZCZEPANSKI PC
Other - Org Name:HEALTHY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, AND OD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:SZCZEPANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-827-8981
Mailing Address - Street 1:2021 44TH ST SE STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5349
Mailing Address - Country:US
Mailing Address - Phone:616-827-8981
Mailing Address - Fax:616-827-2702
Practice Address - Street 1:2021 44TH ST SE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-5349
Practice Address - Country:US
Practice Address - Phone:616-827-8981
Practice Address - Fax:616-827-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6133350001OtherNATIONAL GOV'T SVC-PTAN
MI0P43120OtherGROUP NUMBER
MIP43120001OtherMEDICARE PROVIDER NUMBER