Provider Demographics
NPI:1629064316
Name:MCNIVEN, GEORGE WILLIAM (OD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAM
Last Name:MCNIVEN
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 1:269 N CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CARSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48419-9197
Mailing Address - Country:US
Mailing Address - Phone:810-657-9521
Mailing Address - Fax:
Practice Address - Street 1:33 W SANILAC RD
Practice Address - Street 2:BOX 112
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1036
Practice Address - Country:US
Practice Address - Phone:810-648-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0148520001Medicare NSC