Provider Demographics
NPI:1477739373
Name:EXPERIENCE YOUR EYE SPECIALIST
Entity Type:Organization
Organization Name:EXPERIENCE YOUR EYE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:NORFLEET
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-846-6009
Mailing Address - Street 1:529 S MAIN ST
Mailing Address - Street 2:PO BOX 429
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9539
Mailing Address - Country:US
Mailing Address - Phone:989-846-6009
Mailing Address - Fax:989-846-4889
Practice Address - Street 1:529 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9539
Practice Address - Country:US
Practice Address - Phone:989-846-6009
Practice Address - Fax:989-846-4889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXPERIENCE YOUR EYE SDPECIALIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4487020Medicaid
MI1013421OtherMCLAREN
MI900Z610040OtherBCBS
MI900Z610040OtherBCBS
MI4487020Medicaid