Provider Demographics
NPI:1629054127
Name:VOLLINK, MICHAEL T (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:VOLLINK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3164 PORT SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9317
Mailing Address - Country:US
Mailing Address - Phone:616-538-0150
Mailing Address - Fax:616-669-8457
Practice Address - Street 1:3164 PORT SHELDON ST
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-9317
Practice Address - Country:US
Practice Address - Phone:616-538-0150
Practice Address - Fax:616-669-1890
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003346152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3484982Medicaid
MIU46246Medicare UPIN
0557910001Medicare NSC
MI3484982Medicaid