Provider Demographics
NPI:1609959089
Name:ECENBARGER EYE CARE, LLC
Entity Type:Organization
Organization Name:ECENBARGER EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ECENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-532-2020
Mailing Address - Street 1:5751 BYRON CENTER AVE SW
Mailing Address - Street 2:SUITE V
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9621
Mailing Address - Country:US
Mailing Address - Phone:616-532-2020
Mailing Address - Fax:616-532-2022
Practice Address - Street 1:5751 BYRON CENTER AVE SW
Practice Address - Street 2:SUITE V
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9621
Practice Address - Country:US
Practice Address - Phone:616-532-2020
Practice Address - Fax:616-532-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICURRENTLY APPLYING152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty