Provider Demographics
NPI:1629112750
Name:MICHAEL A BIDDLE O.D., P.C., INC
Entity Type:Organization
Organization Name:MICHAEL A BIDDLE O.D., P.C., INC
Other - Org Name:JONESVILLE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-505-4028
Mailing Address - Street 1:461 OLDS ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250
Mailing Address - Country:US
Mailing Address - Phone:517-849-9277
Mailing Address - Fax:517-849-2134
Practice Address - Street 1:461 OLDS ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-9433
Practice Address - Country:US
Practice Address - Phone:517-849-9277
Practice Address - Fax:517-849-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
MI4901004600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4539708 TYPE 94Medicaid
MIDD7170OtherRRMC GROUP #
MI35212OtherHEALTH PLAN OF MI
MI2844410 TYPE 94Medicaid
MI900C010240OtherBCBS GROUP#
MIDD7170OtherRRMC GROUP #