Provider Demographics
NPI:1457521692
Name:DAVID J. SCHOLTEN, OD, PC
Entity Type:Organization
Organization Name:DAVID J. SCHOLTEN, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHOLTEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-243-0007
Mailing Address - Street 1:2350 32ND ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7901
Mailing Address - Country:US
Mailing Address - Phone:616-243-0007
Mailing Address - Fax:616-243-0540
Practice Address - Street 1:2350 32ND ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-7901
Practice Address - Country:US
Practice Address - Phone:616-243-0007
Practice Address - Fax:616-243-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D16575OtherBLUE CROSS/BLUE SHIELD OF MI
MI4350446Medicaid
MI4350446Medicaid
MI0D16575Medicare PIN
MI0149520001Medicare NSC