Provider Demographics
NPI:1073631040
Name:PINCONNING FAMILY EYE CARE PC
Entity type:Organization
Organization Name:PINCONNING FAMILY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LALONDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-879-3937
Mailing Address - Street 1:1948 N HURON RD
Mailing Address - Street 2:P.O. BOX 325
Mailing Address - City:PINCONNING
Mailing Address - State:MI
Mailing Address - Zip Code:48650-7909
Mailing Address - Country:US
Mailing Address - Phone:989-879-3937
Mailing Address - Fax:989-879-3981
Practice Address - Street 1:1948 N HURON RD
Practice Address - Street 2:
Practice Address - City:PINCONNING
Practice Address - State:MI
Practice Address - Zip Code:48650-7909
Practice Address - Country:US
Practice Address - Phone:989-879-3937
Practice Address - Fax:989-879-3981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRL003052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944704688Medicaid
MI944704688Medicaid