Provider Demographics
NPI:1619089935
Name:PLATZ, DEANA R (OD)
Entity Type:Individual
Prefix:DR
First Name:DEANA
Middle Name:R
Last Name:PLATZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:650 LINDEN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1880
Mailing Address - Country:US
Mailing Address - Phone:231-796-0010
Mailing Address - Fax:231-796-2496
Practice Address - Street 1:650 LINDEN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1880
Practice Address - Country:US
Practice Address - Phone:231-796-0010
Practice Address - Fax:231-796-2496
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901003941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E40039OtherBLUE CROSS BLUE SHIELD GROUP
MI128029001OtherADMINISTAR
MI1619089935OtherCOMMERCIAL INSURERS
MI383209247OtherVSP
MI655OtherSTERLING VISION
MI900E410210OtherBCBS OF MI
MICG0293OtherMEDICARE RAILROAD GROUP
MIP00195275OtherMEDICARE RAILROAD
MI383209247OtherVSP
MI1280290001Medicare NSC
MI0N95880001Medicare PIN