Provider Demographics
NPI:1689858391
Name:JOHN E SCHLAFLEY
Entity Type:Organization
Organization Name:JOHN E SCHLAFLEY
Other - Org Name:DBA GRANDVILLE OPTICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLAFLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-531-3336
Mailing Address - Street 1:4070 CHICAGO DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1258
Mailing Address - Country:US
Mailing Address - Phone:616-531-3336
Mailing Address - Fax:616-988-4786
Practice Address - Street 1:4070 CHICAGO DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1258
Practice Address - Country:US
Practice Address - Phone:616-531-3336
Practice Address - Fax:616-988-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0669810001Medicare NSC