Provider Demographics
NPI:1497086334
Name:EYES TO SEE PEDIATRIC OPHTHALMOLOGY PLLC
Entity Type:Organization
Organization Name:EYES TO SEE PEDIATRIC OPHTHALMOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:VREDEVOOGD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-953-0387
Mailing Address - Street 1:200 TAFT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1692
Mailing Address - Country:US
Mailing Address - Phone:616-953-0387
Mailing Address - Fax:
Practice Address - Street 1:200 TAFT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1692
Practice Address - Country:US
Practice Address - Phone:616-953-0387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071619207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty