Provider Demographics
NPI:1548566862
Name:E DORAN KASPER OD PC
Entity Type:Organization
Organization Name:E DORAN KASPER OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:DORAN
Authorized Official - Last Name:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-629-5387
Mailing Address - Street 1:234 W. CAROLINE ST.
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2807
Mailing Address - Country:US
Mailing Address - Phone:810-629-5387
Mailing Address - Fax:810-629-5390
Practice Address - Street 1:234 W. CAROLINE ST.
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2807
Practice Address - Country:US
Practice Address - Phone:810-629-5387
Practice Address - Fax:810-629-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002329152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U29927Medicare UPIN
B56559Medicare PIN
0816670001Medicare NSC