Provider Demographics
NPI:1508871393
Name:GRAND VIEW OPHTHALMOLOGY PLC
Entity Type:Organization
Organization Name:GRAND VIEW OPHTHALMOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-988-8787
Mailing Address - Street 1:4070 CHICAGO DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1258
Mailing Address - Country:US
Mailing Address - Phone:616-988-8787
Mailing Address - Fax:616-988-4786
Practice Address - Street 1:4070 CHICAGO DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1258
Practice Address - Country:US
Practice Address - Phone:616-988-8787
Practice Address - Fax:616-988-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID