Provider Demographics
NPI:1679968044
Name:TOWNLINE FAMILY PC
Entity Type:Organization
Organization Name:TOWNLINE FAMILY PC
Other - Org Name:KALKASKA FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SKRZYPCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-633-8595
Mailing Address - Street 1:7100 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-9623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:882 M 72 NW
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-8787
Practice Address - Country:US
Practice Address - Phone:231-258-9781
Practice Address - Fax:231-258-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty