Provider Demographics
NPI:1871510859
Name:FERRIS STATE UNIVERSITY
Entity Type:Organization
Organization Name:FERRIS STATE UNIVERSITY
Other - Org Name:UNIVERSITY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL RECORDS/INSURANCE SPECIALIS
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:231-591-3056
Mailing Address - Street 1:1124 S STATE
Mailing Address - Street 2:101 H.
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307
Mailing Address - Country:US
Mailing Address - Phone:231-591-2020
Mailing Address - Fax:231-591-3991
Practice Address - Street 1:1124 S STATE
Practice Address - Street 2:101 H
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307
Practice Address - Country:US
Practice Address - Phone:231-591-2020
Practice Address - Fax:231-591-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI180E410080OtherBLUE CROSS
MI999998001OtherVSP
900E47602OtherBLUE CROSS
900E476020OtherBLUE CROSS
MI0M41110OtherMEDICARE
MI900006367OtherPRIORITY HEALTH
900E476020OtherBLUE CROSS
MI180E410080OtherBLUE CROSS
MI900006367OtherPRIORITY HEALTH
0E47602Medicare PIN