Provider Demographics
NPI:1891778189
Name:CUTLERVILLE EYECARE, P.C.
Entity Type:Organization
Organization Name:CUTLERVILLE EYECARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-455-2525
Mailing Address - Street 1:6680 S DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-7834
Mailing Address - Country:US
Mailing Address - Phone:616-455-2525
Mailing Address - Fax:616-455-9135
Practice Address - Street 1:6680 S DIVISION AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-7834
Practice Address - Country:US
Practice Address - Phone:616-455-2525
Practice Address - Fax:616-455-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D178450OtherBCBS
MI2587297Medicaid
MI2587297Medicaid
MI900D178450OtherBCBS