Provider Demographics
NPI:1245515345
Name:GLADSTONE EYE CARE PC
Entity type:Organization
Organization Name:GLADSTONE EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:906-420-8322
Mailing Address - Street 1:20 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837-1526
Mailing Address - Country:US
Mailing Address - Phone:906-420-8322
Mailing Address - Fax:906-420-8322
Practice Address - Street 1:20 S 10TH ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MI
Practice Address - Zip Code:49837-1526
Practice Address - Country:US
Practice Address - Phone:906-420-8322
Practice Address - Fax:906-420-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty