Provider Demographics
NPI:1407077290
Name:NHH VISION GROUP, S.C.
Entity Type:Organization
Organization Name:NHH VISION GROUP, S.C.
Other - Org Name:VISION SOURCE KINGSFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:H
Authorized Official - Last Name:HASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:906-774-0611
Mailing Address - Street 1:401 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802-4630
Mailing Address - Country:US
Mailing Address - Phone:906-774-0611
Mailing Address - Fax:906-774-2796
Practice Address - Street 1:401 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802-4630
Practice Address - Country:US
Practice Address - Phone:906-774-0611
Practice Address - Fax:906-774-2796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38578900Medicaid
MI0M79730Medicare PIN
MICS6986Medicare PIN
WI38578900Medicaid