Provider Demographics
NPI:1548596695
Name:VISUALEYES CENTER OF VISUAL DEVELOPMENT, PLLC
Entity Type:Organization
Organization Name:VISUALEYES CENTER OF VISUAL DEVELOPMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:269-751-4400
Mailing Address - Street 1:6231 138TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9716
Mailing Address - Country:US
Mailing Address - Phone:269-751-4400
Mailing Address - Fax:269-751-5365
Practice Address - Street 1:3426 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MI
Practice Address - Zip Code:49419-9512
Practice Address - Country:US
Practice Address - Phone:269-751-4400
Practice Address - Fax:269-751-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003563261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center