Provider Demographics
NPI:1639493588
Name:RAPIDS OPHTHALMOLOGY, P.C.
Entity Type:Organization
Organization Name:RAPIDS OPHTHALMOLOGY, P.C.
Other - Org Name:CREW EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-796-0010
Mailing Address - Street 1:650 LINDEN ST
Mailing Address - Street 2:STE 5
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1879
Mailing Address - Country:US
Mailing Address - Phone:231-796-0010
Mailing Address - Fax:231-796-2496
Practice Address - Street 1:491 W SHAW ST
Practice Address - Street 2:
Practice Address - City:HOWARD CITY
Practice Address - State:MI
Practice Address - Zip Code:49329-9401
Practice Address - Country:US
Practice Address - Phone:231-937-8206
Practice Address - Fax:231-937-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDP003941152W00000X
MIRC008359207W00000X
MIJB013778207W00000X
MIBC042824207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E41021OtherBCBSM
MI0E41065OtherBCBSM
MI0E41065OtherBCBSM
MI0N95580Medicare PIN
MI0N95570Medicare PIN
MI0E41021OtherBCBSM