Provider Demographics
NPI:1568528198
Name:SW MICHIGAN EYE CENTER PLC
Entity Type:Organization
Organization Name:SW MICHIGAN EYE CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:VANDERPLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-979-6383
Mailing Address - Street 1:3600 CAPITAL AVE SW
Mailing Address - Street 2:STE 203
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9393
Mailing Address - Country:US
Mailing Address - Phone:269-979-6383
Mailing Address - Fax:269-979-6381
Practice Address - Street 1:3600 CAPITAL AVE SW
Practice Address - Street 2:STE 203
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9393
Practice Address - Country:US
Practice Address - Phone:269-979-6383
Practice Address - Fax:269-979-6381
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SW MICHIGAN EYE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-28
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3182490Medicaid