Provider Demographics
NPI:1376759738
Name:BIG RAPIDS FAMILY EYE CARE PLLC
Entity Type:Organization
Organization Name:BIG RAPIDS FAMILY EYE CARE PLLC
Other - Org Name:BIG RAPIDS FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:COLES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-796-5321
Mailing Address - Street 1:207 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1809
Mailing Address - Country:US
Mailing Address - Phone:231-796-5321
Mailing Address - Fax:231-796-2957
Practice Address - Street 1:207 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1809
Practice Address - Country:US
Practice Address - Phone:231-796-5321
Practice Address - Fax:231-796-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900E460050OtherBCBSM
MI1376759738Medicaid
MI1508869272Medicaid
MI1871514596Medicaid
MI410026859OtherMEDICARE RR
MI410026860OtherMEDICARE RR
MI0E4600500OtherMEDICARE ADVANTAGE
MI1073534798Medicaid
MI1871514596Medicaid
MI1073534798Medicaid