Provider Demographics
NPI:1568758209
Name:DR MARIE FOX PLC
Entity Type:Organization
Organization Name:DR MARIE FOX PLC
Other - Org Name:KALAMAZOO VALLEY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:269-375-3937
Mailing Address - Street 1:4855 W CENTRE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4686
Mailing Address - Country:US
Mailing Address - Phone:269-375-3937
Mailing Address - Fax:269-375-3938
Practice Address - Street 1:4855 W CENTRE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4686
Practice Address - Country:US
Practice Address - Phone:269-375-3937
Practice Address - Fax:269-375-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2012-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1568758209Medicaid
MI0C90390OtherBCBS PIN
MI200000030622OtherPHP PROVIDER NUMBER
MI0C90369OtherBCBS PIN
MI0C90390OtherBCBS PIN
MI200000030622OtherPHP PROVIDER NUMBER