Provider Demographics
NPI:1639137508
Name:EC ONE, INC.
Entity Type:Organization
Organization Name:EC ONE, INC.
Other - Org Name:EYE CARE ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-846-0620
Mailing Address - Street 1:105 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2024
Mailing Address - Country:US
Mailing Address - Phone:616-846-0620
Mailing Address - Fax:616-844-6079
Practice Address - Street 1:1231 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1484
Practice Address - Country:US
Practice Address - Phone:231-924-2700
Practice Address - Fax:231-924-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900F210170OtherBCBSM
MI=========OtherTAX ID
MI900F210170OtherBCBSM
MI5375940001Medicare NSC
MIU54539Medicare UPIN
MIU37641Medicare UPIN
MI5375940004Medicare NSC
MI5375940002Medicare NSC
MI0P15470Medicare PIN
MI5375940006Medicare NSC
MI0P13290Medicare PIN
MI=========OtherTAX ID
MIU37640Medicare UPIN
MIU32355Medicare UPIN
MIU59119Medicare UPIN