Provider Demographics
NPI:1205990363
Name:SEVENSMA, DAVID GENE (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GENE
Last Name:SEVENSMA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 FIVE MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6518
Mailing Address - Country:US
Mailing Address - Phone:616-361-6601
Mailing Address - Fax:616-361-6601
Practice Address - Street 1:2730 FIVE MILE RD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6518
Practice Address - Country:US
Practice Address - Phone:616-361-6601
Practice Address - Fax:616-361-6601
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2473152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0201620001Medicare NSC