Provider Demographics
NPI:1790828622
Name:LAINGSBURG EYE CARE P.C.
Entity Type:Organization
Organization Name:LAINGSBURG EYE CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-651-6608
Mailing Address - Street 1:252 E GRAND RIVER RD
Mailing Address - Street 2:PO BOX 218
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-8600
Mailing Address - Country:US
Mailing Address - Phone:517-651-6608
Mailing Address - Fax:517-651-6603
Practice Address - Street 1:252 E GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848-8600
Practice Address - Country:US
Practice Address - Phone:517-651-6608
Practice Address - Fax:517-651-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMB003617152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2270117Medicaid
MI26475OtherSPECTERA
MIMI3617OtherEYEMED
MILAINGSBURGEYEOtherDELTA VISION
MI200000000289AOtherPHP
MI5176516608OtherVSP
MI26475OtherSPECTERA
MI2270117Medicaid
MI1313040001Medicare NSC