Provider Demographics
NPI:1598934150
Name:CEDAR SPRINGS EYE CARE INC
Entity Type:Organization
Organization Name:CEDAR SPRINGS EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHOMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-696-0830
Mailing Address - Street 1:26 S MAIN
Mailing Address - Street 2:P.O. BOX 683
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8936
Mailing Address - Country:US
Mailing Address - Phone:616-696-0830
Mailing Address - Fax:616-696-4724
Practice Address - Street 1:26 S MAIN
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-5118
Practice Address - Country:US
Practice Address - Phone:616-696-0830
Practice Address - Fax:616-696-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3403115Medicaid
MI3403115Medicaid