Provider Demographics
NPI:1568520716
Name:ENSMINGER, JOEL E (OD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:E
Last Name:ENSMINGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2718 OLDEPOINTE DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-3021
Mailing Address - Country:US
Mailing Address - Phone:616-363-3708
Mailing Address - Fax:616-949-2170
Practice Address - Street 1:2974 28TH ST SE
Practice Address - Street 2:STE A
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-1664
Practice Address - Country:US
Practice Address - Phone:616-949-2120
Practice Address - Fax:616-949-9015
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901002617152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU33231Medicare UPIN
MIN26930164Medicare PIN