Provider Demographics
NPI:1417942152
Name:BELLOWS, RODNEY WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:WAYNE
Last Name:BELLOWS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PALUSTER ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2532
Mailing Address - Country:US
Mailing Address - Phone:231-775-7341
Mailing Address - Fax:231-775-3925
Practice Address - Street 1:120 PALUSTER ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2532
Practice Address - Country:US
Practice Address - Phone:231-775-7341
Practice Address - Fax:231-775-3925
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5098250Medicaid
MI5098250Medicaid
MIOH37621Medicare ID - Type Unspecified