Provider Demographics
NPI:1508829573
Name:CREEKSIDE VISION & HEARING, PLC
Entity Type:Organization
Organization Name:CREEKSIDE VISION & HEARING, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-945-3888
Mailing Address - Street 1:1761 W M-43 HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-8378
Mailing Address - Country:US
Mailing Address - Phone:269-945-3888
Mailing Address - Fax:269-945-2112
Practice Address - Street 1:1761 W M-43 HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-8378
Practice Address - Country:US
Practice Address - Phone:269-945-3888
Practice Address - Fax:269-945-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P04740Medicare PIN
MI0498690001Medicare NSC