Provider Demographics
NPI:1336602911
Name:ZENVISION
Entity Type:Organization
Organization Name:ZENVISION
Other - Org Name:EAST LANSING FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-580-8733
Mailing Address - Street 1:1905 ABBOT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8571
Mailing Address - Country:US
Mailing Address - Phone:517-580-8733
Mailing Address - Fax:517-337-1854
Practice Address - Street 1:1905 ABBOT RD STE 1
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8571
Practice Address - Country:US
Practice Address - Phone:517-580-8733
Practice Address - Fax:517-337-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP1606001OtherINDIVIDUAL PTAN