Provider Demographics
NPI:1932300928
Name:VISION ASSOCIATES OF WESTLAND
Entity Type:Organization
Organization Name:VISION ASSOCIATES OF WESTLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOUDEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-326-2160
Mailing Address - Street 1:38979 CHERRY HILL RD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186
Mailing Address - Country:US
Mailing Address - Phone:734-326-2160
Mailing Address - Fax:734-326-9678
Practice Address - Street 1:38979 CHERRY HILL RD.
Practice Address - Street 2:SUITE B
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186
Practice Address - Country:US
Practice Address - Phone:734-326-2160
Practice Address - Fax:734-326-9678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002809152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900H221100OtherBCBS
MI900H221100OtherBCBS
MI0862660001Medicare NSC