Provider Demographics
NPI:1578505160
Name:VERDIER EYE CENTER, PLC
Entity Type:Organization
Organization Name:VERDIER EYE CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-949-2001
Mailing Address - Street 1:1000 E PARIS AVE SE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3680
Mailing Address - Country:US
Mailing Address - Phone:616-949-2001
Mailing Address - Fax:616-949-8620
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:STE 130
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3680
Practice Address - Country:US
Practice Address - Phone:616-949-2001
Practice Address - Fax:616-949-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 174400000X, 207W00000X, 207WX0120X
MI207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4478667Medicaid
MI4457907Medicaid
MI1654958Medicaid
MI4094391Medicaid
MIG81418Medicare UPIN
MI4094391Medicaid
MI4457907Medicaid
MIH54422Medicare UPIN
MI0N85130Medicare ID - Type Unspecified
MI4478667Medicaid