Provider Demographics
NPI:1396832937
Name:THORNAPPLE OPHTHALMOLOGY ASSOC PC
Entity Type:Organization
Organization Name:THORNAPPLE OPHTHALMOLOGY ASSOC PC
Other - Org Name:ADVANCED EYECARE PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLOHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-897-7000
Mailing Address - Street 1:915 W GREEN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1723
Mailing Address - Country:US
Mailing Address - Phone:269-945-3866
Mailing Address - Fax:269-945-9388
Practice Address - Street 1:915 W GREEN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1724
Practice Address - Country:US
Practice Address - Phone:269-945-3866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004379152W00000X
MI4901004439152W00000X
MI4301047122207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102575680Medicaid
MI0M43420Medicare PIN
MIA73646Medicare UPIN
MI102575680Medicaid
MI0171290003Medicare NSC
MI0171290001Medicare NSC