Provider Demographics
NPI:1477928612
Name:BALA, JAMIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:BALA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8692
Mailing Address - Country:US
Mailing Address - Phone:616-395-0606
Mailing Address - Fax:616-395-0077
Practice Address - Street 1:27838 NOVI RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3019
Practice Address - Country:US
Practice Address - Phone:248-348-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-12
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist