Provider Demographics
NPI:1336250026
Name:MUSKEGON COOPERATIVE, INC
Entity Type:Organization
Organization Name:MUSKEGON COOPERATIVE, INC
Other - Org Name:CO-OPTICAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:PRESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-733-2685
Mailing Address - Street 1:499 W NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3727
Mailing Address - Country:US
Mailing Address - Phone:231-733-2685
Mailing Address - Fax:231-737-1236
Practice Address - Street 1:499 W NORTON AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3727
Practice Address - Country:US
Practice Address - Phone:231-733-2685
Practice Address - Fax:231-737-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900F17620OtherBC/BS OF MICHIGAN
MI0628600001Medicare ID - Type Unspecified