Provider Demographics
NPI:1467475723
Name:KALAMAZOO OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:KALAMAZOO OPHTHALMOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-329-5860
Mailing Address - Street 1:3412 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4624
Mailing Address - Country:US
Mailing Address - Phone:269-329-5860
Mailing Address - Fax:269-329-5865
Practice Address - Street 1:3412 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4624
Practice Address - Country:US
Practice Address - Phone:269-329-5860
Practice Address - Fax:269-329-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
180C960320OtherBCBS GROUP
MIFS003034OtherFERRIS STANDIFORD
1863900012OtherGREGORY BIBART
900C965580OtherFERRIS STANDIFORD
MIGB072121OtherGREGORY BIBART
1803906051OtherGREGORY BIBART
MISH405954OtherSTEPHEN HIGGINS
MI2669516Medicaid
180C910010OtherBCN GROUP
MI4415148Medicaid
1803901811OtherSTEPHEN HIGGINS
MI4073524Medicaid
MI4415148Medicaid
1863900012OtherGREGORY BIBART
T96815Medicare UPIN
MI2669516Medicaid
180C910010OtherBCN GROUP
=========OtherGROUP TAX ID
0N31700Medicare ID - Type UnspecifiedFERRIS STANDIFORD