Provider Demographics
NPI:1578535126
Name:ADVANCED OPTOMETRY, P.L.L.C.
Entity Type:Organization
Organization Name:ADVANCED OPTOMETRY, P.L.L.C.
Other - Org Name:DRS. BELLOWS & MYERS, OPTOMETRISTS PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-775-7341
Mailing Address - Street 1:120 PALUSTER ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2532
Mailing Address - Country:US
Mailing Address - Phone:231-775-7341
Mailing Address - Fax:231-775-3925
Practice Address - Street 1:120 PALUSTER ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2532
Practice Address - Country:US
Practice Address - Phone:231-775-7341
Practice Address - Fax:231-775-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002495152W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0663030001Medicare NSC
MICA9854Medicare PIN
MI0H37621Medicare PIN