Provider Demographics
NPI:1619328226
Name:FERGASON, EMELIE JOY (OD)
Entity Type:Individual
Prefix:
First Name:EMELIE
Middle Name:JOY
Last Name:FERGASON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:EMELIE
Other - Middle Name:JOY
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2001 COOLIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1378
Mailing Address - Country:US
Mailing Address - Phone:517-337-0316
Mailing Address - Fax:517-337-1779
Practice Address - Street 1:2001 COOLIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1378
Practice Address - Country:US
Practice Address - Phone:517-337-1668
Practice Address - Fax:517-337-1779
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005171152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901005171OtherSTATE LICENSE