Provider Demographics
NPI:1669133229
Name:WOODBRIDGE FAMILY EYE CARE
Entity type:Organization
Organization Name:WOODBRIDGE FAMILY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-860-2994
Mailing Address - Street 1:4070 CHICAGO DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1258
Mailing Address - Country:US
Mailing Address - Phone:616-531-3336
Mailing Address - Fax:
Practice Address - Street 1:4070 CHICAGO DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1258
Practice Address - Country:US
Practice Address - Phone:616-531-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty