Provider Demographics
NPI:1639418932
Name:WEST MICHIGAN VISION SPECIALISTS
Entity Type:Organization
Organization Name:WEST MICHIGAN VISION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-534-4953
Mailing Address - Street 1:4467 BYRON CENTER AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4808
Mailing Address - Country:US
Mailing Address - Phone:616-534-4953
Mailing Address - Fax:616-534-9790
Practice Address - Street 1:4467 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4808
Practice Address - Country:US
Practice Address - Phone:616-534-4953
Practice Address - Fax:616-534-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003563152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty