Provider Demographics
NPI:1972671469
Name:DAVE'S VISION CENTER INC.
Entity Type:Organization
Organization Name:DAVE'S VISION CENTER INC.
Other - Org Name:SMEELINK OPTICAL OF GRANDVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAVERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-531-7840
Mailing Address - Street 1:4565 WILSON AVE SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2371
Mailing Address - Country:US
Mailing Address - Phone:616-531-7840
Mailing Address - Fax:616-532-5748
Practice Address - Street 1:4565 WILSON AVE SW
Practice Address - Street 2:SUITE 1
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2371
Practice Address - Country:US
Practice Address - Phone:616-531-7840
Practice Address - Fax:616-532-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003291152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1279900001Medicare NSC
MI0P40240Medicare PIN